Clinical, Director (RN, LCSW or LPC)

Acentra Health, LLC•UNAVAILABLE, UNAVAILABLE

About The Position

Acentra Health is seeking a Clinical Director to direct and oversee clinical program activities, with an emphasis on consistency, thoroughness, and accuracy. The role guides the program toward greater clinical efficiency and ensures deliverables and assigned contract functions meet high standards. The Clinical Director oversees utilization management, care coordination, case management, clinical quality, contract activities, and staff development. The position monitors contractual and operational indicators, identifies opportunities to improve efficiency, supports organizational priorities, and serves as a subject matter expert. The role also requires adherence to corporate policies, including HIPAA Privacy and Security Rules.

Requirements

Active, unrestricted RN license (including compact state) or active, unrestricted Licensed Clinical Social Worker (LCSW) or LPC license.
Extensive experience managing clinical care management (utilization management) operations.
At least 3 years of utilization review experience.
At least 2 years of clinical management experience.
Strong verbal and written communication skills.
Customer-focused and results-oriented, with the ability to build and maintain relationships with internal and external customers.
Organizational skills and the ability to plan and prioritize multiple assignments.
Ability to examine and reevaluate operations and procedures, formulate policy, and develop and implement strategies and procedures.
Ability to participate as a team member and foster collaborative decision-making among diverse leaders, committees, teams, or workgroups.
Proficiency in Microsoft Office applications and other software needed for job functions.
Ability to develop, plan, and implement short- and long-range goals.
Skill in employee development and performance management.
Ability to provide technical guidance and leadership to the management team.
Advanced communication skills and ability to work effectively with a wide range of constituencies in a diverse community.

Nice To Haves

Bachelor's degree or equivalent directly applicable experience in nursing, healthcare administration, or a related area is preferred.
Current working knowledge of utilization management, case management, and managed care.
Current knowledge of InterQual and Milliman criteria.
Familiarity with the U.S. healthcare industry.
Experience using systems that support utilization and case management processing.
Demonstrated expertise in managing diverse customer needs.
Understanding of URAC standards and processes.

Responsibilities

Conduct utilization management reviews across specialties including Advanced Imaging, Audiology, Chiropractic, Dental, DME, Home Health, Hospice, Inpatient, Mental Health, MRO, Occupational Therapy, Optometry, Outpatient, Pharmacy, Physical Therapy, Physician, Podiatry, Rehabilitation, Speech Therapy, Transplant, and Transportation.
Manage care coordination services for a specific member population.
Guide direct reports responsible for utilization management review and case management.
Monitor critical indicators and adjust processes to ensure clinical operations comply with contractual requirements and address negative variances.
Identify opportunities to enhance operating efficiencies.
Serve as a subject matter expert.
Contribute to annual organizational priorities and operational indicators.
Foster effective staff communication through one-on-one, team, and interdepartmental meetings.
Oversee contract activities, including service level agreement metrics, processes, staff development, internal training, review quality, case management effectiveness, deliverables, and budget compliance.
Manage the clinical quality program, including auditing, Quality Improvement Plans, and administration of the Local Quality Improvement Committee.
Perform other duties as assigned.
Read, understand, and follow corporate policies, including HIPAA Privacy and Security Rules.