Company Description:
Clearlink Partners is an industry-leading clinical and operational consultancy, specializing in total cost of care that provides optimized end-to-end clinical and operational management programs for managed care organizations, health plans, providers and health systems. Through expert insights, innovative processes and comprehensive solutions, Clearlink helps healthcare companies improve enterprise-wide alignment and navigate a dynamic healthcare ecosystem.

Position Responsibilities:
Specific

• Responsible for providing evidence of ongoing compliance with all regulatory and accreditation requirements (i.e. Health Risk Assessments and Interdisciplinary Care Plans)
• Responsible for working with key stakeholders to provide subject matter expertise in support of the oversight, outreach and training of the Plan Partner Health Plans and Delegated Provider Groups.
• Develops and implements operational business plans and departmental objectives to support organization strategies
• Oversees and monitors operational compliance with Client’s organizational standards, policies and procedures and regulatory requirements.

General

• Provide oversight and management for assigned engagements and activities
• Conduct Clinical Management Service assessments to understand and document opportunities to improve performance as compared to industry standard/ best practice
• Leverages assessment finds to develop gap reports and summary recommendations for decision/ action by the Client
• Understand and make budgetary recommendations based on ROI and associated financial impacts
• Manage Clinical Management transformation engagement(s) to support improvement in performance of key clinical operations metrics, organization compliance and quality outcomes
• Design/ implement overall department structure such that a) staffing is appropriate and cost-effective; b) technology use is maximized; and c) staff and operational performance standards are met or exceeded.
• Act in interim leadership capacity to provide supervision and oversight for Client clinical management teams and activities (clinical management, utilization management, quality and care management/disease management) in a direct supervisory model
• Act as “Co-Sourced” leadership, identifying opportunities to improve workflow, generate accurate, high quality productivity, support organizational compliance with requirements and deliver reductions in associated costs with improvement in organizational quality performance in collaboration with Client operations leads, care management staff and CLP co-sourced teams
• Lead, develop, and mentor a UM team. Developing staff performance plans, providing performance feedback, managing direct reports and performing personnel actions in accordance with policy & procedure.
• Responsible for coordinating/ facilitating education of physicians, managers, staff, members and families related to the clinical management processes. Supports the organization growth/ expansion by observing Client for future needs
• Acts as liaison to facilitate communication and collaboration between all care partners based on the Client Model of Care
• Work closely with senior management and medical director(s) to ensure interdisciplinary collaboration necessary to effectively deploy clinical strategies and promote efficient operations
• Develop and Deliver staff training and in-services
• Develop and deploy management reporting, if indicated, to support monitoring and improvement of performance for discipline specific identified/ tracked key performance indicators, implementing plans for improvement as necessary
• Responsible for the engagement quality, maintaining appropriate resources, competency training and education of staff
• Responsible for approving and managing day to day engagement resourcing/ time and attendance as an Engagement Manager
• Oversee compliance with internal client related audits, support Client preparation for external audits and surveys
• Collaborate with corporate quality, to ensure standardization of NCQA program requirements to support Client accreditation and recognition
• Promote interdisciplinary collaboration, foster teamwork and champion service excellence
• Uses data to drive decisions, plan, and implement performance improvement strategies for Client Clinical Management activity

Position Qualifications:

• Competencies:
  • Excellent Communication – oral and written
  • Flexibility and willingness to adapt to changing expectations
  • Data analysis and problem solving
  • Change Management Principles
  • Leading and managing teams
  • Delivering results aligned to key metrics and success criteria
  • Emotional intelligence

• Experience:
  • Bachelors Degree in Nursing or other Affiliated Health Care Discipline required
  • Master’s Degree Preferred
  • Medicaid/Duals experience
  • Certified Case Manager preferred
  • Proficient in Milliman Care Guidelines, NCQA guidelines
  • Bilingual (English/Spanish) preferred
  • Bilingual (English/Vietnamese) preferred
  • 5+ years of experience in a clinical leadership position in Managed Care environment
  • Experience working with disadvantaged populations helpful and knowledge of health disparities highly desired
  • Experience working with related legal and regulatory requirements required
  • Experience managing an interdisciplinary team in a fast paced, time-sensitive environment
  • Demonstrated ability to motivate performance with successful outcomes
  • Project planning and management

• Time Zone: Mountain or Pacific

Other Information:

• Expected Hours of Work: Monday – Friday 8a.m. – 5 pm; with ability to adjust to Client schedules as needed
• Travel: May be required, as needed by Client
• Direct Reports: None

EEO Statement:

It is Clearlink Partners’ policy to provide equal employment opportunity to all employees and applicants without regard to race, sex, sexual orientation, color, creed, religion, national origin, age, disability, marital status, parental status, family medical history or genetic information, political affiliation, military service or any other non-merit-based factor in accordance with all applicable laws, directives and regulations of Federal, state and city entities.