Position Summary
The Regional Manager Clinical Services will be responsible for planning, directing, and overseeing the performance of a team of assigned Provider and Member facing staff. The position will oversee the administrative, clinical, and quality activities related to building strong provider and member engagement and health outcomes.
Responsibilities
- Function as ambassador for organization with all internal and external customers
- Collaborate as needed with team to help engage providers and members and serve as escalation point for difficult practices and/or members
- Implement organization policies, procedures, workflows, and action plans to drive team performance
- Ensure collaboration and communication among multi-disciplinary teams to ensure they are coordinated in working toward maximum customer engagement and improved member outcomes
- Monitor Key Performance Indicators (KPIs) to identify trends and areas of opportunity that will guide regional strategy; Develop action plans and/or remediation strategies to address areas of opportunity
- Develop, monitor, and report on team performance and productivity
- Monitor practice profiles monthly to ensure that practices with newly attributed members are appropriately assigned to a PRT
- Troubleshoot technical issues within Compass and/or Tableau as needed
- Promote an environment of continuous improvement through on-going team audits, provider practice visits, and monitoring of member calls to identify gaps in teams’ skills and competencies; Work to develop ongoing team education to address areas of opportunity
- Develop, coach, and mentor team members to achieve company, department, and individual goals
- Conduct yearly performance evaluations and provide constructive feedback to redirect team members with a positive discipline approach
- Maintain team performance according to National Committee for Quality Assurance (NCQA) standards including but not limited to appropriate provider and member documentation
- Comply with HIPAA privacy laws, all other federal and local regulations, and company security policies
- Provide recommendations to the leadership regarding necessary operational adjustments needed to ensure organizational objectives and goals are met
- Perform other related duties as assigned
Requirements
- Bachelor's degree in nursing required; master’s degree preferred
- Active RN licensure required
- Minimum of two years progressive supervisory and/or management experience required
- 5 years of progressive experience in healthcare services, clinical operations, quality, or care management required
- 5 years of experience in closure of care gaps or care coordination preferred
- Prior experience building and managing relationships with health care providers or patients preferred
- Must reside in Regional Territory: TX, AR, OK, LA or MO
- Proof of valid and unrestricted driver’s license required
Skills
- Excellent verbal, written and presentation skills
- People skills to develop and maintain strong internal and external relationships
- Ability to multitask, prioritize, and create solutions in a challenging environment
- Demonstrated leadership skills and ability to create and maintain a positive work environment
- Strong critical thinking and analytical skills
- Ability to foster strong employee engagement among the team
- Must be proficient in Microsoft Office: Outlook, Word, Excel, PowerPoint
Travel
Moderate Travel, 25% to 50%, in the Midwest (TX, AR, OK, LA, MO)
#LI-Hybrid
