As one of our Regional Directors of Clinical Operations youll manage a team of exceptional clinical program managers who are committed to quality care. This role requires excellent management skills backed by a strong understanding of Medicare, Medicaid and managed care regulations. You will work closely with our nursing home partners to ensure we deliver the highest level of care, while preventing fraud and abuse.

TruHealth is a division of American Health Partners, a multifaceted company with operations in seven states. We own nursing homes, health plans for Medicare beneficiaries living in long-term care facilities, as well as divisions offering psychiatric care, home health, hospice, rehabilitation and specialty pharmacy services. Come grow with us. We offer competitive compensation, generous benefits and advancement opportunities.

POSITION SUMMARY

The Regional Director of Clinical Operations will oversee the markets clinical program managers to support cost-effective, high-quality healthcare for patients enrolled in their long-term care facilities Medicare Advantage Plan. This position is responsible for monitoring performance metrics, implementing growth initiatives, designing and analyzing local interventions to impact acute utilization.

Essential Job Duties:

To perform this job, an individual must accomplish each essential function satisfactorily, with or without a reasonable accommodation.

Directly manage market clinical program managers within designated region

Collaborate with corporate and facility leadership to meet key performance metrics

Ensure all patient services are delivered on time and effectively, within the scope of the plan

Collaborate with colleagues to explore innovative delivery models or enhancements

Identify opportunities for process improvements and staff education to produce optimal results

Serve as a subject matter expert (SME) on the ISNP plan and care model

Assist in the development of training materials to support clinical training; participate in clinical training initiatives

Collaborate with business leaders to implement new markets and programs

Review daily, weekly and monthly management reports to monitor and manage care delivery, including market financials as

applicable to staffing and company resource utilization

Monitor performance metrics

Implement growth initiatives with the Plan

Improve service delivery through collaboration with vendors and community organizations

Oversee the review and resolution of complaints and grievances

Participate in company-wide initiatives to ensure consistency in the clinical delivery of care

Participate in company-wide initiatives across all aspects of the organization

Work with interdepartmental leaders to coordinate care delivery

Ensure adherence to the model of care

Anticipate staffing needs; oversee hiring

Other duties as assigned

Job Requirements

Ensure care is administered in accordance with Medicare, Medicare Advantage and all other compliance programs, state laws

and regulatory compliance

Ensure privacy and security; detect, prevent and correct fraud, waste and abuse

Punctuality, reliability

Successful completion of required training

Drivers license without restrictions; clean driving record

Manage stress appropriately

Handle multiple priorities effectively

Independent discretion/decision making

Make decisions under pressure

Multi-task, meet deadlines, prioritize

Position may require flexible hours, unscheduled overtime or occasional week-end work

Some travel may be required

Required Qualifications

Education:

o Masters degree in Nursing

Experience:

o 5 years experience in business education or healthcare experience required

o 1-3 years of management experience preferred

o Proficient leadership and business skills preferred

o Advanced knowledge of HEDIS/STARs preferred

o Strong background and familiarity with Medicare, Medicaid, I-SNP, nursing facility and managed care desired

License/Certification(s):

o RN or APRN or PA license

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