naviHealth is the result of over a decade of dedicated visionary leaders and innovative organizations challenging the status quo for PAC management solutions. We do healthcare differently and we are changing healthcare one patient at a time. How might you ask? By hiring talented clinicians, engineers, developers, and healthcare leaders to create and utilize cutting edge technology in order to provide the patient with the best level of care for the right amount of time.
Why Is This Role Critical?
The Senior Clinical Manager (SCM) is responsible for management of all clinical functions in the market to ensure consistent, efficient delivery of services throughout the healthcare continuum. The result creates compliance with clinical model, ensures positive outcomes for patients and KPI achievement for the market. The SCM establishes strong relationships with their MA plan or partner hospitals, providers, client peers and other key market stakeholders.
This position requires input into market specific strategy and implementation of innovative clinical programs with fidelity to the naviHealth clinical model. This individual assists the GM in developing strategic direction and creating the annual business plan for the market with consideration to clinical impact of decisions. The SCM is also responsible for maintaining a positive work environment for our naviHealth colleagues, serving as communication link to GM, Corporate and CTM and ensuring compliance with all corporate policies and procedures.
What you will be accountable for….
- Implements and directs naviHealth clinical programs based on the individual needs of the client, identifies variation and proposed pilots to CDO.
- Ensures clinically integrated, patient centric care coordination with a focus on appropriate first PAC setting, appropriate PAC LOS, transitions of care and readmission avoidance
- Supports the concept of being a data driven organization, relying heavily on analytics and outcome reports to drive the business. Includes daily, weekly and monthly report review and analysis.
- Cultivates a strong internal culture designed around collaboration, feedback, motivation, and accountability. Responsible for clinical operations, quality and performance of market.
- Conducts weekly team call with all team members.
- Interviews, hires, and is ultimately responsible for the competency and compliance of all clinical field staff.
- Directly supervises the Clinical Team Manager (CTM). Includes weekly 1x1.
- Works with CTM to maximize colleague performance using nH based reports, audits, record reviews and field based observations.
- Participates in MMR, reviews results with CTM and creates action plans for identified issues.
- Conducts semi -annual and annual colleague performance reviews.
- Supports the CTM in rounds facilitation, field staff observations, colleague recognition and coaching when needed. With human capital support, develops and reviews a documented performance improvement plan with colleagues as appropriate.
- Works with Market Leadership and Human Capital to determine staffing requirements to support work volume.
- May function as a preceptor, mentor or subject matter expert for new colleagues in the market.
- Collaborates with Network Manager to develop business relationship with local providers. Joins and contributes to SNF dashboard presentations.
- Works directly with the GM to review market performance and develop/refine clinical strategy to maximize KPI achievement.
- Evaluates performance to benchmarks, goals and outcomes for all programs as well as high cost, volume and risk conditions.
- May makes recommendations on reporting and analytic needs of the market.
- In conjunction with the GM, attends and participates in the JOC meetings.
- Functions as a liaison to the Local Physician Champion (LPC) to manage readmissions and other in market needs.
- Develops relationships with client/partner peers at the hospital and plan level.
- Monitors Compliance to Implementation Protocols and/or Contract SLA.
- Works collaboratively with the Health Services and Utilization Management departments and programs to ensure positive outcomes.
- Monitors feedback from member satisfaction surveys and provider feedback and identifies process improvement opportunities.
- Ensure compliance with all federal and state regulations, accreditation organizations and client requests.
- Clinical Team Manager
What you will need to be successful in this role…
- Bachelor’s Degree in Nursing or Rehabilitation Services (OT, PT, ST)
- 5-8years of advanced clinical experience
- Familiarity with care management, utilization/resource management processes and disease management programs.
- 5+ years of leadership experience in an inpatient and/or outpatient health care environment.
- Experience managing multi-disciplinary care teams, including nurses, therapists, social workers, case managers.
- Experience in project management and program development/implementation,
- Strong presentation/public speaking skills
- Understanding of the evolving health care market and ability to work collaboratively with physicians.
- Ability to establish realistic and achievable priorities, goals and objectives.
- Proficient with Microsoft Office applications including Word, Excel and Power Point.
- Master’s degreepreferred
- Certification in case management (Commission for Case Management Certification (CCMC); Association of Rehabilitation Nurses (ARN) if appropriate) Preferred
- Knowledge of InterQual and Milliman a plus.
- Knowledge of NCQA and URAC standards a plus.