RN Regional Manager, Clinical Services (Must reside in Florida)

Healthmap Solutions•Miami, FL

3d•$100,855 - $152,585•Hybrid

About The Position

The Regional Manager, Clinical Services plans, directs, and oversees the performance of assigned provider- and member-facing staff. The role oversees administrative, clinical, and quality activities that support strong provider and member engagement and improved health outcomes. The position emphasizes provider-facing work and serves as an organizational ambassador to internal and external customers. The manager supports engagement efforts, addresses escalated practice or member issues, and works with multidisciplinary teams to improve customer engagement and member outcomes. The role monitors team performance and productivity, reviews KPIs to guide regional strategy, and develops action or remediation plans. It promotes continuous improvement through audits, provider practice visits, and monitoring member calls, and includes developing, coaching, and mentoring team members. The manager conducts annual performance evaluations, maintains performance according to NCQA standards, ensures appropriate documentation, and complies with HIPAA, applicable regulations, and company security policies. The position also provides recommendations to leadership on operational adjustments and performs other related duties as assigned. The employee must reside in Florida and should expect moderate travel, up to 25%, throughout the state.

Requirements

Bachelor's degree in healthcare or a related field.
Active, unrestricted RN license.
At least 3 years of progressive supervisory and/or management experience.
At least 5 years of progressive experience in healthcare services, clinical operations, quality, or care management.
Valid and unrestricted driver's license.
Ability to successfully comply with the credentialing process.
Excellent verbal, written, and presentation skills.
Ability to develop and maintain strong internal and external relationships.
Ability to multitask, prioritize, and create solutions in a challenging environment.
Demonstrated leadership skills and ability to create and maintain a positive work environment.
Strong critical-thinking and analytical skills.
Ability to foster strong employee engagement among the team.
Proficiency in Microsoft Office, including Outlook, Word, Excel, and PowerPoint.

Nice To Haves

Master's degree.
At least 5 years of experience in closure of care gaps or care coordination.
Prior experience building and managing relationships with healthcare providers or patients.

Responsibilities

Serve as an ambassador for the organization with internal and external customers.
Collaborate with the team to engage providers and members and serve as an escalation point for difficult practices or members.
Implement organizational policies, procedures, workflows, and action plans to drive team performance.
Ensure communication and collaboration among multidisciplinary teams working toward customer engagement and improved member outcomes.
Monitor KPIs, identify trends and opportunities, guide regional strategy, and develop action or remediation plans.
Develop, monitor, and report on team performance and productivity.
Troubleshoot technical issues as needed.
Promote continuous improvement through ongoing team audits, provider practice visits, and monitoring of member calls; develop team education to address gaps.
Develop, coach, and mentor team members toward company, department, and individual goals.
Conduct yearly performance evaluations and provide constructive feedback using a positive discipline approach.
Maintain team performance according to NCQA standards, including appropriate provider and member documentation.
Comply with HIPAA privacy laws, other federal and local regulations, and company security policies.
Recommend operational adjustments to leadership to help meet organizational objectives and goals.
Perform other related duties as assigned.
Travel up to 25% throughout Florida.