Clinical Program Manager

TruHealth•St. Louis, MO

14d

About The Position

The Clinical Program Manager supports cost-effective, high-quality health care for patients enrolled in long-term care facilities in their region. The role manages a team of providers and supports national clinical strategy and leadership. It conducts clinical audits to ensure excellent service delivery and that care complies with Medicare, Medicare Advantage, other compliance programs, state laws and regulations, privacy and security requirements, and standards for detecting, preventing, and correcting fraud, waste, and abuse. The manager works with long-term care facility leadership and company leaders to meet market performance metrics; oversees care delivery, staff, training, and quality initiatives; and collaborates with colleagues, business leaders, vendors, and community organizations to improve services and implement new markets and programs. The role also serves as a subject matter expert on the I-SNP plan and care model and oversees complaint and grievance review and resolution.

Requirements

Required APRN or PA license.
3–5 years of experience in long-term care or with chronically ill patients.
3–5 years of practice experience.
Unrestricted driver’s license and good driving record.
Working knowledge of Microsoft Office, including Word, Excel, PowerPoint, SharePoint, and Visio.

Nice To Haves

1–3 years of management experience in long-term care, home health, or chronic condition management.
Strong experience in leadership and business.
Strong background and familiarity with Medicare, Medicaid, I-SNP, nursing facilities, and managed care.
Strong working knowledge of HEDIS/STARs.

Responsibilities

Work with long-term care facility and company leadership to meet key market performance metrics.
Directly manage providers and RN Case Managers delivering care in nursing facilities.
Ensure patient services are timely, effective, and within the scope of the plan.
Collaborate with colleagues to explore innovative delivery models and enhancements to current care models and practices.
Identify process improvement and staff education opportunities to produce optimal outcomes.
Serve as a subject matter expert on the I-SNP plan and care model.
Collaborate on developing clinical training materials and 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 to improve service delivery.
Oversee review and resolution of complaints and grievances.
Participate in company-wide initiatives to promote consistency and high quality in clinical care delivery.
Participate in company-wide quality improvement initiatives across the organization.
Supervise and delegate duties to Providers (NPs/PAs) and RN Case Managers providing direct clinical care.
Oversee, plan, and delegate onboarding activities for new employees in the designated region.
Address provider relations issues that are not at a regional or corporate level and that may affect policies and procedures.