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Director of Clinical Services #2

Posted 2 years ago in Healthcare



JOB DESCRIPTION:
(We are looking for a Director with a nursing background and an insurance background...Must have management experience and be comfortable speaking with clients and 3rd party payers)

Our company provides Nurse Practitioners and Physicians Assistants to Medicare Advantage members homes to conduct H&P's on them.

Scope:
The Director Clinical Operations provides leadership and management for the Albany market impactable care management program, which includes transition of care and hospice referral components. This position is also responsible for client relations, building trust, confidence and goodwill with our customer. The Director will understand the needs of the customer and articulate our ability to meet the client’s needs. The Director fulfills all administrative duties and is responsible for the highest quality member services while ensuring a cost effective operation. This position assures that the care managers in the field and office based care coordinators provide CCS members with the best quality impactable care management. This position has direct oversight of the quality improvement case review process, data management, feedback, continuing education development, and the certification and recertification needs of all the clinical staff.

Measures of success:
-Quality (55%)
-30%Meeting Hospital Admission goals
-10% Meeting 90 day hospital readmission rate goals
-10% Meeting performance guarantees (i.e. Star)
-5%90% chart audits exceed standards
-Financial (35%)
-20%Meeting profitability goals
-15%Managing expenses to budget
-Productivity (10%)
-10% Visits/Field FTE/Day

Responsibilities:
Hire, train, measure and monitor skill levels of staff, assign case loads, duties and delegate responsibilities as appropriate, complete performance evaluations, track productivity and attendance
Develop client relationship and govern all interactions with client
Manage hospital admissions and readmissions to meet program goals
Manage budget to achieve financial program goals
Recommend program changes or enhancements toward achieving targets/metrics
Troubleshoot and resolve issues with client, members, caregivers and/or providers
Conduct case conferencing with staff on team
Assist with urgent and complex cases
Train and educate staff on Quality Improvement (QI) initiatives, new and updated clinical policies, departmental workflow and protocols
Responsible for approval of timesheets including PTO and expenses
Perform special projects and assignments as directed by management
Requirements:
Registered Nurse, licensed in New York
At least three (3) to five (5) years of management experience in a related health care organization with responsibilities in administration, financial management, and operations, preferred.
Three years’ experience in one of the following: direct supervision of heath care/patient care services, working in care management, in home care or other outpatient setting managing programs within budgeting limitations.
Minimum of one year in nursing management
Intermediate skill levels of Microsoft Word, Excel and Outlook
Knowledge, Skills and Abilities:
Requires excellent interpersonal skills both internally and externally
Knowledge of the healthcare delivery systems
Knowledge of basic Medicare and Medicaid rules and regulations
Knowledge of managed care methods, procedures, rules and regulations
Requires excellent written and verbal communication skills
Requires good organizational and strong analytical skills
Requires ability to work in a high volume environment with moderate supervision

Supervisory Accountability Statement:
Maintains a motivated and productive staff by providing sound leadership and direction. Models appropriate behaviors, renders timely decisions, and provides coaching, feedback and recognition. Conducts timely and appropriate performance appraisals. Selects the best qualified candidates to fill job vacancies, administers company policies fairly, and provides for development activities and opportunities to assure application and assessment skills are learned.

Compliance Statement:
As a supervisor, complies with the laws, regulations, and takes reasonable steps to ensure that staff members know and understand laws, regulations, and policies that pertain to the organizational units business and takes reasonable steps to assure staff conform their actions accordingly

Cultural Drivers:

*Integrated thinking and action
*Adult to adult communication
*Accountability
*Business partnership
*Change identifier and supporter
*Customer focus
*Data driven decisions
*Getting results


CONTACT:
Phone 931 455 2279
Fax 267 393 7697

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