Job Description

This job is located in Milledgeville, GA.

JOB SUMMARY:

The Clinical Program Manager is responsible for supporting cost-effective, high-quality health care for patients enrolled in long-term care facilities within a designated region by managing the activities performed by a team of Providers and to support national clinical strategy and leadership. This position is responsible for conducting clinical audits of the providers to ensure excellent delivery of service and verifying that care is administered in accordance with all compliance programs, Medicare, Medicare Advantage, state laws and regulatory compliance, privacy and security.

ESSENTIAL JOB DUTIES:

To perform this job, an individual must perform each essential function satisfactorily, with or without a reasonable accommodation.
• Work closely with the leadership at the long-term care facilities in their region and company leadership to meet the key performance metrics for a market
• Directly manage a team of Providers and RN Case Managers who provide care within nursing facilities
• Ensure all patient services are delivered timely, effectively and within the scope of the plan
• Collaborate with colleagues to explore innovative delivery models or enhancements to current delivery models and care
practices
• Identify opportunities for process improvements and staff education to produce optimal outcomes
• Serve as a subject matter expert (SME) on the institutional special needs plans (I-SNP) and care model
• Collaborate on the development of training materials to support clinical training
• Participate in clinical training initiatives
• Collaborate with business leaders to implement new markets and programs
• Review daily, weekly and monthly management reports to monitor and manage care delivery
• Collaborate with vendors and community organizations for improved service delivery
• Oversee the review and resolution of complaints and grievances
• Participate in company-wide initiatives to ensure consistency and high-quality in the clinical delivery of care
• Participate in company-wide quality improvement initiatives across all aspects of the organization
• Ensure care is provided in compliance with all state laws and regulations
• Detect, prevent and correct fraud, waste and abuse
• Other duties as assigned

JOB REQUIREMENTS:

• Ability to work designated schedule, reliable attendance
• Skilled business background
• Proficient leadership skills
• Knowledge of HEDIS and STAR ratings
• Knowledge of Medicare, Medicaid, I-SNP, Nursing Facility and Managed Care
• Proficient knowledge of Microsoft Office applications

REQUIRED QUALIFICATIONS:

Education:

• Master’s degree in nursing

Experience:

• 3 to 5 years’ experience in long-term care or with chronically ill patients3-5 years of practice experience
• 1-3 years management experience in long-term care, home health or chronic condition management preferred
• Vast experience in leadership and business preferred
• Extensive knowledge and experience with Medicare, Medicaid, I-SNP, Nursing Facility and Managed Care
  preferred
• HEDIS / STARs experience preferred

License/Certification(s):

• APRN or PA license required

SUPERVISORY RESPONSIBILITES:

• First line supervision and delegation of duties to all Providers (NPs/PAs) and RN Case Managers in direct clinical care
  services
• Frontline oversight, planning, and delegation of onboarding activities of new employees within the designated region
• Responsible for provider relations issues below regional or corporate levels that would affect P&Ps
• Supervise support staff including scheduling and assigning work, reviewing performance, recommending salary increases,
  promotions or discharges
• Occasionally needs manager’s direction due to extraordinary circumstances

EQUAL OPPORTUNITY EMPLOYER

This Organization is an equal opportunity employer. We do not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. This Organization will make reasonable accommodations for qualified individuals with disabilities should a request for an
accommodation be made. A key part of this policy is to provide equal employment opportunity regarding all terms and conditions of employment and in all aspects of a person's relationship with the Organization including recruitment, hiring, promotions, upgrading positions, conditions of employment, compensation, training, benefits, transfers, discipline, and termination of employment.

Licenses & Certifications

• Family Nurse Practitioner
• Nurse Practitioner
• APRN Advanced Practice RN
• Physician Assistant

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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