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 directing Care Management operations and leading a team of 10-12 RNs to deliver services that engage, motivate, and educate family caregivers
• Ensures the delivery of high-quality services in compliance with all DHCS state, program, and accreditation requirements.
• Manages a team of clinical care managers, providing case management services across the continuum of care (assessment, care planning, care coordination, and monitoring and evaluating services).
• Creates action plans in support of quality improvement efforts and positive health outcomes.
• Oversee Care Management functions and ensure consistency and compliance with clinical policy, procedure and best practices, including regulatory and contractual agreements as well as NCQA accreditation requirements
• Track and trend outcomes for potential improvements in the care management process. Create monitors, evaluate and disseminate programmatic reports weekly, monthly, and as needed
• Provide oversight for the appropriate use of tools and person-centered care plans to support caregiver and care recipient needs; provide regular review of incidents to identify cause and recommend interventions.
• Support and maintain clinical relationships with key external business partners and referral sources to increase care collaboration and foster credibility in our services
• Review and analyze data (e.g. hospitalization rates, falls, incidents, activation, suspension, and discharge rates) and engage care management team to determine improvement opportunities and manage interventions.

General

• Provide management for assigned engagements, staff and activities
• Understand opportunities to improve performance as compared to industry standard/ best practice
• Manage activities outlined in Clinical Management transformation engagement(s)
• Support organizational improvement in performance of key clinical operations metrics, organization compliance and quality outcomes
• Implement recommended department structure changes to ensure appropriate coverage, optimized efficiency and improved performance
• Act in interim leadership capacity to provide supervision and oversight for Client clinical teams and activities (clinical management, utilization management, quality and care management/disease management) in a direct supervisory model
• Act as “Co-Sourced” leadership to identify 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 leaders and teams
• Develop, and mentor UM staff
• Manage staff performance providing performance feedback, managing direct reports and performing personnel actions in accordance with policy & procedure.
• Responsible for coordinating/ facilitating education of physicians, staff, members and families related to the clinical management processes.
• 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:

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.