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Job Description
Job Title RN Clinical Manager (Colette Lewis EDOS 6/17/13)
Job ID 706896
Begin Date 4/24/13
Duration
Location Rockville,  MD
Other Location
Description At Collaborative Health Systems, we are passionate about changing behaviors of all constituents in the healthcare system to improve health, optimize clinical quality, and reduce associated costs. Our mission is quite simply to improve the health of those we serve.
 
You will have an exciting opportunity to be part of the implementation and operation of Accountable Care Organizations (ACOs) aimed at increasing care coordination, improving quality of care and reducing costs for Medicare members. ACOs are designed to achieve the three part aim of better care, improved health and lower per capita costs. Improved health will be accomplished through prevention and chronic care management. The aim of the ACO is intended to reduce the trend of cost increases associated with the Medicare fee for service population.
 
CHS is seeking a RN Clinical Manager to join this new and exciting program. The RN Clinical Manager develops and oversees clinical departments including interactions with physician advisors, account providers, patients and other internal CHS departments on a regular basis. This individual addresses quality improvements related to key program metric outcomes, Clinical Services staff quality improvements, identified participant service issues, and/or new initiatives designed to improve the reach and engagement of identified participants within the contracted population. This position will be based remotely from a home office and requires travel within the Rockville region.
 
Essential Functions:
•             Manages programs for the following areas: behavioral healthcare management, disease management, case management, utilization review, inspections of care and special reviews. Resource for direct reports regarding:  protocol, staffing issues, troubleshooting, conflict resolution, (internal and external). 
•             Designs and implements departmental policies and procedures and ensures compliance.
•             Provides and coordinates training to providers and state agency contacts on prior authorization processes, programs and services and other related areas.
•             Supervises clinical staff and quality assurance program including the APS Interrater Reliability Program and the APS Internal Quality Control program.
•             Serves on the Clinical Services Committees.
•             Manages departmental budget and necessary reports.
•             Develops and maintain strong business and clinical relationships with state officials, facilities and providers in a manner that enhances the value of APS Healthcare.
 
Education:
•             Bachelors of Science in Nursing, Public Health or Healthcare Administration strongly desired.  Associates or Diploma in Nursing with a minimum of four years of related experience minimally required.
•             Must hold a current registered nursing licensure in the state of Maryland.
•             For Case Management programs, a minimum 2 years experience in direct patient care required.
 
Qualifications:
•             Minimum 3 – 5 years experience in healthcare field required.
•             For Case Management programs, a minimum 2 years experience in direct patient care required.
•             Minimum of 3 years management experience required.
•             Previous experience with managed care, or public/private -sponsored medical management preferred.
•             Thorough knowledge of managed care and medical management processes and strategies.
•             Thorough understanding of strategies pertaining to the management and supervision of senior clinical staff members.
•             Thorough understanding of Medicaid, Medicare and other public health care purchasing systems.
•             Proficiency in Microsoft Office Suite, particularly Word, Excel, PowerPoint, and MS Project.
•             Proficiency in care management application systems.
•             Excellent written and verbal communication skills.
•             Strong customer relationship skills.
•             Strong problem solving skills.
•             Ability to work remotely as required.
•             Ability to analyze project progress and make adjustments as necessary to timelines, strategies, or approach.
•             Ability to identify key outcomes and metrics.
 
Required Skills Qualifications:
• Minimum 3 – 5 years experience in healthcare field required.
• For Case Management programs, a minimum 2 years experience in direct patient care required.
• Minimum of 3 years management experience required.
• Previous experience with managed care, or public/private -sponsored medical management preferred.
• Thorough knowledge of managed care and medical management processes and strategies.
• Thorough understanding of strategies pertaining to the management and supervision of senior clinical staff members.
• Thorough understanding of Medicaid, Medicare and other public health care purchasing systems.
• Proficiency in Microsoft Office Suite, particularly Word, Excel, PowerPoint, and MS Project.
• Proficiency in care management application systems.
• Excellent written and verbal communication skills.
• Strong customer relationship skills.
• Strong problem solving skills.
• Ability to work remotely as required.
• Ability to analyze project progress and make adjustments as necessary to timelines, strategies, or approach.
• Ability to identify key outcomes and metrics.
 
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