Clinical Operations Manager (Hybrid in Illinois)

at Kepro in Chicago, Illinois, United States

Job Description

CNSI and Kepro are now Acentra Health! Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the company’s mission, actively engage in problem-solving, and take ownership of your work daily. Acentra Health offers unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes, making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

Acentra seeks a Clinical Operations Manager – RN (Remote U.S.) to join our growing team.

Job Summary:

The Clinical Operations Manager – RN:

· Manages the day-to-day operations for Clinical Operations, Utilization Management, and/or Clinical Reviewers, assuring quality customer service and support for clients and staff.

· Develops and enforces operational policies and procedures, manages staff, monitors, and manages correspondence between external stakeholders and the company, and reports operational status to leadership.

Job Responsibilities:

The Clinical Operations Manager – RN is responsible for:

· Coordinates and directs clinical operations and related programs and directly supervises clinical support staff. Coordinates special programs such as automated outreach systems and incentive plans.

· Develops and maintains procedures and practices for accomplishing departmental or program goals and objectives.

· Develops and monitors business and financial metrics related to the program’s day-to-day operational success, reports, and measures progress toward operational goals through periodic reviews.

· Coordinates all aspects of clinical operations, including program coordination, scheduling, work plan management, status reporting, and issue resolution tracking.

· Assumes responsibilities for the Director, Operations in their absence.

· Resolves program or department operations issues or delegates to the appropriate personnel or staff members for prompt resolution.

· Supervising and managing the day-to-day activities of the assigned case management and utilization review teams.

· Mentoring, coaching, and training team members in the case management process to ensure quality and contract deliverables are met.

· Using independent judgment, utilizing clinical knowledge and competence, communication skills, problem-solving, and conflict resolution to effectively ensure optimal client outcomes, considering payor/client requirements.

· Working effectively with all healthcare team members internally and externally.

· Supporting the interdisciplinary team with the underlying objectives of maximizing enrollment, enhancing the quality of clinical outcomes (including participant satisfaction), ensuring contractual, regulatory, and accreditation compliance, and providing timely and accurate data and communications.

· Supervises, mentors, coaches, trains, and develops the:

o Case review and utilization review teams within the clinical domain of case review and dispute resolution while ensuring the team’s high clinical expertise and performance, embracing a compassionate leadership approach throughout the case review process.

o Case management team in the care coordination/case management of participants; ensures a high level of clinical knowledge and performance by the clinical team.

· Fosters a caring philosophy in leadership and all aspects of the case management process.

· Effectively manages team assignments, evaluating and addressing workload to align with departmental demands and contractual obligations. Adjusts staff assignments and tasks to enhance member-related results and client satisfaction.

· Applies a comprehensive knowledge of case management, care coordination, and caring concepts to all aspects of clinical assignments.

· Identifies the ongoing educational needs of case review staff. Develops and executes plans for orientation and continuous learning to enhance team competencies.

· Performs quality monitoring activities, including identifying areas for improvement for individual team members, processes, and quality improvement initiatives.

· Ensures compliance with regulatory and accreditation standards and contractual service level agreements.

· Participates in developing, implementing, evaluating, and revising clinical pathways/assessments and care plans, and other case management tools that specifically support case management programs.

· Maintains open communication with all appropriate parties and facilitates communication to/between members of the care team; ensures accurate and timely documentation and reporting.

· Maintains strict standards for client confidentiality and client-related information; complies with all organizational, state, and federal regulations and policies on confidentially.

· Performs other duties related to case management supervision functions as needed.

The above list of accountabilities is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary from time to time.

Requirements

Required Qualifiations/Experience:

+ Active, unrestricted RN licensure for Illinois.

+ Bachelor’s degree in Nursing.

+ 5+ years of clinical experience in a medical or behavioral health setting.

+ 3+ years of Case Management and/or Utilization Review experience.

+ Knowledge of clinical aspects of nursing/case management/utilization review management with a focus on geriatrics and chronic diseases.

+ Ability to utilize critical thinking and apply sound judgment for decision-making and guiding staff.

+ Experience in quality management, including involvement in projects, reporting outcomes, or other Quality Improvement Programs (QIP).

+ Achieves a URAC-recognized certification in case management within three (3) years of directly supervising the case management process.

+ Ability to organize and manage tasks efficiently with minimal supervision.

+ Exceptional supervisory, organizational, and time management skills, with the ability to handle multiple competing contractual and team-related priorities.

+ Computer proficiency in Microsoft Office and other software programs and the ability to enter and retrieve data from relevant computer systems.

+ Excellent verbal and written communication skills; excellent interpersonal communication and negotiation skills.

+ Required to pursue ongoing education, certification, and self-development to remain current with case management standards.

+ Demonstrates the ability to be organized and efficient in prioritizing and managing assignments with minimal oversight and direction.

+ Understanding of the importance of instilling a caring philosophy in all aspects of the case management process.

+ Experience in public and private sector healthcare and/or involvement in providing services to government or commercial programs.

+ Skill in examining and re-examining operations and procedures, formulating policy, and developing and implementing new strategies and procedures.

+ Knowledge of the U.S. healthcare industry, preferably with experience in both public and private sectors.

+ Expertise in employee development and performance management skills.

+ Ability to analyze resources and environment appropriate to the scope of responsibility and design a course of action consistent with the company’s mission and strategic plan.

+ Demonstrated achievement in P&L management, operational process engineering, remote operations management, and new business d