Clinical Program Manager

TruHealth•Indianapolis, IN

About The Position

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.

Requirements

APRN or PA license required
3-5 Years of experience in long term care or chronically ill patients
3-5 years of practice experience needed
Driver’s license without restrictions and good driving record
Working knowledge of MS 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 preferred
Strong experience in leadership and business preferred.
Strong background and familiarity with Medicare, Medicaid, ISNP, Nursing Facility and Managed Care preferred
Strong working knowledge of HEDIS/ STARs preferred

Responsibilities

Works 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 manages a team of Providers and RN Case Managers who are providing care in nursing facilities
Ensures all patient services are delivered on time and effectively and within the scope of the plan.
Collaborates with colleagues to explore innovative delivery models or enhancements to current delivery models and care practices.
Identifies opportunities for process improvements and staff education to produce optimal outcomes
Serves as a subject matter expert (SME) on the ISNP plan and care model.
Collaborates on the development of training materials to support clinical training
Participates in clinical training initiatives
Collaborates with business leaders to implement new markets and programs
Reviews daily, weekly and monthly management reports to monitor and manage care delivery.
Collaborates with vendors and community organizations for improved service delivery
Oversees the review and resolution of complaints and grievances
Participates in company-wide initiatives to ensure consistency and high-quality in the clinical delivery of care
Participates in company-wide quality improvement initiatives across all aspects of the organization
First line supervision and delegation of duties of all the 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 that are not at a regional or corporate level that would affect P&Ps