Clinical Operations, Manager

Acentra Health, LLC•UNAVAILABLE, UNAVAILABLE

17h•Remote

About The Position

Acentra Health seeks a Clinical Operations Manager - RN to supervise and manage the day-to-day activities of assigned Case Review Teams. The role mentors, coaches, and trains team members in case review to support quality outcomes and contractual deliverables. It applies clinical knowledge, independent judgment, communication, problem-solving, and conflict-resolution skills to support optimal client outcomes while meeting payer and client requirements. The manager works with internal and external healthcare team members and supports the interdisciplinary team in meeting contractual, regulatory, and accreditation requirements while providing timely, accurate data and communications. This is a remote position. Regular working hours are Monday through Friday, 9:00 AM to 5:30 PM EST. Work may occasionally be required in the evenings, on holidays, and on weekends. The listed annual pay range is USD $93,520 to $105,000; placement depends on applicable experience and skill level.

Requirements

Active, unrestricted RN licensure.
Pursue ongoing education, certification, and self-development to remain current with case review standards.
At least 4 years of clinical experience in a medical setting.
Quality management experience involving projects, outcome reporting, or other quality improvement program involvement.
Case review experience using evidence-based practice standards.
Knowledge of the No Surprises Act and dispute resolution.

Nice To Haves

Bachelor’s degree in nursing or a related nursing field.
Previous workload management experience.
Previous client management experience.
Strong supervisory experience and knowledge; Independent Dispute Resolution experience is recommended.
Strong team-building skills.
Excellent verbal and written communication, interpersonal communication, and negotiation skills.
Ability to use critical thinking and sound judgment in decision-making and staff guidance.
Understanding of the importance of fostering a caring philosophy throughout the case review process.
Analytical, reporting, and data management skills.
Strong organizational and time management skills, including the ability to prioritize multiple tasks.
Ability to organize and manage assignments efficiently with minimal oversight and direction.
Computer proficiency in Microsoft Office and other software, and ability to enter and retrieve data from relevant computer systems.

Responsibilities

Supervise, mentor, coach, and develop the case review team in case review and dispute resolution, supporting strong clinical knowledge and performance and fostering a caring philosophy.
Oversee team assignments and workload; assess and address workload needs, adjust coverage to meet departmental and contract requirements, measure results, and initiate personnel actions as required.
Identify orientation and ongoing learning needs with direct leadership, and develop and implement plans to address those needs.
Conduct quality monitoring, identify improvement opportunities for team members and processes, and support quality improvement initiatives.
Ensure compliance with regulatory and accreditation standards and contractual service level agreements.
Participate in developing, implementing, evaluating, and revising case review tools.
Maintain open communication with appropriate parties, facilitate communication among care team members, and ensure accurate and timely documentation and reporting.
Protect confidential client and client-related information and comply with organizational, state, and federal confidentiality requirements and policies.
Participate as a member of the leadership team in contract management activities and contract administration deliverables.
Perform other duties related to case review supervision as needed.
Read, understand, and adhere to corporate policies, including HIPAA Privacy and Security Rules.