Senior Manager Clinical Network Operations

Paradigm

12h

About The Position

Paradigm is an accountable specialty care management organization focused on improving the lives of people with complex injuries and diagnoses. The company has been a pioneer in value-based care since 1991 and has an exceptional track record of generating the very best outcomes for patients, payers, and providers. Deep clinical expertise is the foundation for every part of Paradigm’s business: risk-based clinical solutions, case management, specialty networks, home health, shared decision support, and payment integrity programs.
We’re proud to be recognized—again! For the fourth year in a row, we’ve been certified by Great Place to Work®, and for the third consecutive year, we’ve earned a spot on Fortune's Best Workplaces in Health Care™ list. These honors reflect our unwavering commitment to fostering a positive, inclusive, and employee-centric culture where people thrive.
Paradigm is seeking a Senior Manager Clinical Network Operations. This position holds primary accountability for facilitation, coordination and management of the clinical networks, internal clinicians and contracted business partners that primarily support the Risk / Catastrophic products. The Senior Manager, Clinical Network Operations, works collaboratively with the Senior Director, Clinical Network Operations, to ensure the administrative management of performance and training of the clinical networks. This position contributes to the oversight of new NWM preparation to function independently, in addition to compliance with business processes and activities/communication that enhance elevated network performance.

Requirements

• Bachelor’s degree in nursing or health care specialty from an accredited university considered (must possess certification and relevant experience). Master’s Degree preferred.
• Licensed Registered Nurse (RN) preferred with active, unrestricted licensure.
• CCM, CRRN or CNE, Nursing Professional Development certification preferred.
• Minimum 5-7 years of experience in the management of clinical resources, demonstrated knowledge of case management services provided for catastrophically injured individuals with CCM certification required.
• Thorough knowledge of healthcare delivery systems, standards of care for catastrophic diagnoses, case management, public and private resources required.
• Prior experience with mentoring, skill development, and teaching the adult learner.
• Prior experience using a variety of instructional tools and technology in developing high-quality, and engaging learning materials.
• Excellent verbal and written communication skills. Demonstrated ability to simplify complex material for learning and development, utilize negotiation/conflict resolution skills to resolve issues, and provide creative solutions and ideas.
• Able to travel as needed.

Responsibilities

• Network Recruitment, Selection and Development
• Contribute to the recruitment, application, and selection process for Network business partners and Network Manager candidates in collaboration with the Workforce Development team and Selection Committee leaders.
• Support the oversight of clinical network onboarding and readiness to function independently.
• Preceptor Program Oversight
• Assist the Senior Director in the oversight of the Clinical Preceptor Manager, network business preceptors, and PMD preceptors.
• Contribute to the management and oversight of all precepting programs, including ensuring completion of required preceptor training.
• Audit precepting activities for quality and compliance with established procedures.
• Lead and support preceptor meetings in conjunction with the Senior Director, Clinical Network Operations, and the Clinical Preceptor Manager.
• Analyze preceptor evaluation metrics and implement continuous quality improvement initiatives.
• Collaborate with clinical training staff to ensure development, implementation, and availability of supporting training materials.
• Performance Management and Issue Resolution
• Support performance management of clinical networks for risk products by analyzing performance metrics, developing action plans, and collaborating with business owners and internal partners.
• Investigate network complaints, resolve performance concerns, and assist with customer service issues related to PMC performance.
• When necessary, communicate directly with customers and injured workers in partnership with internal team members.
• Policy, Procedure and Compliance
• Contribute to the development, implementation, and monitoring of policies and procedures with operational impact to Paradigm’s Networks.
• Ensure case management practice guidelines, internal field perspectives, and marketplace requirements are integrated into operational design and procedures.
• Utilize industry-standard guidelines and references, including:
• CCMC Code of Professional Conduct
• CMSA Standards of Practice
• ACOEM, ODG, and jurisdictional workers’ compensation requirements
• Security and Incident Management
• Assist the Senior Director with PMC security incidents for risk networks.
• Support investigation, documentation, and reporting of all security-related incidents involving PMCs in collaboration with the Senior Director and Clinical Preceptor Manager.
• Clinical Summit and Special Projects
• Contribute to Catastrophic Clinical Summit planning, including ensuring appropriate operational and financial support.
• Participate in and lead Summit project workgroups as assigned.
• Serve as a designated back-up for the Senior Director, Clinical Network Operations during time off or periods of conference scheduling overload.
• Quality Assurance and Training
• In collaboration with the Network Quality Analyst, develop, implement, and support Quality Assurance initiatives with network-wide clinical impact.
• Intervene with clinical staff based on quality data analysis and provide performance recommendations to Network Services leadership.
• Contribute as a developer and editor to training programs, network communications, and company-sponsored clinical education initiatives.
• Operational Coverage and Industry Engagement
• Provide weekend coverage for referral handling on a rotating basis with other managers.
• Maintain a comprehensive clinical knowledge base and awareness of industry trends, standards, and current events related to workers’ compensation, medical economics, and healthcare.

Benefits

• Health and wellness– We want our people to be and stay healthy, so we offer PPO, HDHP, and HMO health insurance options with Cigna and Kaiser (CA employees only).
• Financial incentives- Paradigm’s financial benefits help prepare you for the future: competitive salaries, 401(k) matching contributions, employer-paid life and disability insurance, flexible spending, and employer-matched HSA contributions.
• Vacation - We believe strongly that work-life balance is good for you and for our company. We offer paid time off, paid holidays, and a personal holiday.
• Volunteer Time - We want our employees to engage with and give back to their communities in meaningful ways. Full and part-time employees receive one paid day per calendar year.
• Learning and development - One of Paradigm's core values is expertise, so we encourage our employees to continually learn and grow. We support this in a variety of ways from our Dedicated Training Department that offers an 8-12 week new hire onboarding program.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level