Clinical Program Manager

TruHealth•Oklahoma City, OK

2h•Hybrid

About The Position

TruHealth supplies contracted nurse practitioners and physician assistants to skilled nursing facilities in six states. TruHealth clinicians collaborate with facility providers and administrators to address the full range of patients’ medical, mental health and social needs. In addition to providing routine healthcare services, TruHealth providers also act as care coordinators for individuals enrolled in Institutional Special Needs Plans (I-SNPs), a type of Medicare plan for nursing home residents. TruHealth is a division of Franklin, Tennessee-based American Health Partners Inc. The purpose of this position is to be responsible for supporting cost-effective, high-quality health care for patients enrolled in the long-term care facilities in their region by managing the activities of a team of Providers and supports national clinical strategy and leadership. The Program Manager is responsible for conducting clinical audits of the providers to ensure excellent service deliver, and that care is administered in accordance with Medicare, Medicare Advantage, and all other compliance programs, state laws and regulatory compliance, privacy and security, detecting, preventing, and correcting fraud, waste, and abuse. 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.

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
Punctuality, reliability
Successful completion of required training
Manage stress appropriately
Handle multiple priorities effectively
Independent discretion/decision making
Make decisions under pressure
Position may require flexible hours, unscheduled overtime or occasional week-end work
Unrestricted driver’s license; clear driving record
Some travel may be required
Standard office equipment
Microsoft Suite applications
SharePoint
Visio
Ability to learn HRIS and/or scheduling systems
Master’s degree in nursing
3 to 5 years’ experience in long-term care or with chronically ill patients
3-5 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
APRN or PA license required

Nice To Haves

1-3 years management experience in long-term care, home health or chronic condition management
Vast experience in leadership and business
Extensive knowledge and experience with Medicare, Medicaid, I-SNP, Nursing Facility and Managed Care
HEDIS / STARs experience

Responsibilities

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
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