What are the responsibilities and job description for the Manager, Clinical Performance position at premiermedical?
WHO WE ARE
NeueHealth is a value-driven healthcare company grounded in the belief that all health consumers are entitled to high-quality, coordinated care. By uniquely aligning the interests of health consumers, providers, and payors, we help to make healthcare accessible and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid.
NeueHealth delivers clinical care to health consumers through our owned clinics – Centrum Health and Premier Medical – as well as unique partnerships with affiliated providers across the country. We also enable providers to succeed in performance-based arrangements through a suite of technology and services scaled centrally and deployed locally. Through our value-driven, consumer-centric approach, we are committed to transforming healthcare and creating a better care experience for all.
JOB SUMMARY
The Manager, Clinical Performance is responsible for the direct management of the clinical staff supporting Neuehealth’s clinical programs. programs. The Manager provides day-to-today supervision of assigned UM staff. The Manager monitors consistent application of UM Criteria by staff, for each level and type of UM decision. The Manager monitors documentation for adequacy. The Manager will have responsibility for ensuring clinical teams are aligned with the NeueHealth Model of Care.
DUTIES & RESPONSIBILITIES
The Manager, Clinical Performance job description is intended to point out major responsibilities within the role, but it is not limited to these items.
-
Able to perform the functions of the clinical teams to which the supervisor has direct reporting responsibility, based on scope of practice.
-
Responsible for the performance and outcome monitoring data at defined intervals that accurately reflects clinical program activities, key performance indicators and workplans where applicable.
-
Responsible for supporting clinical director in the development of performance improvement plans based on deficiencies in key performance indicators
-
Responsible for supporting onboarding training and continued education for clinical staff and care partners
-
Responsible for ensuring the model of care is consistently applied throughout clinical services.
-
Able to complete value stream mapping and desktop procedures to ensure program standardization
-
Responsible for supporting clinical directors in conducting care team meetings for care partners.
-
Adheres to the Policies and Procedures set forth by the Quality Management Committee and performs all additional duties as assigned
EDUCATION AND PROFESSIONAL EXPERIENCE
(Licensures AND Certifications)
-
Bachelor’s degree in nursing, Business, or other related Healthcare field preferred
-
Certified Case Management preferred
-
Minimum 1 year experience in a supervisory capacity
-
Minimum 5 years’ experience in medical management (Case Management, Utilization Management)
-
Training experience preferred
PROFESSIONAL COMPETENCIES
(List professional knowledge, attitude, and skills required in order to work in the job)
-
Active and unrestricted license as a Registered Nurse (RN) or Licensed Vocational Nurse (LVN)
-
High Attention to detail and Strong analytical skills
-
High level of critical thinking and problem-solving skills
-
Strong work ethic and overall positive attitude
-
Effective communication skills including verbal and written
-
Ability to manage time effectively, understand directions, and work independently in a fast-paced environment
-
Demonstrated flexibility, organization, and self-motivation
-
Highly adaptable to change