Universal American

RN Clinical Manager

Job Title: RN Clinical Manager

Job ID: 939778

Begin Date: 3/31/15

Duration

Location: Tualatin, OR

Other Location

Description: APS Healthcare, a subsidiary of Universal American, is a healthcare company with over two decades of pioneering innovative collaborations between patients, doctors and our company that produce healthy outcomes for all. Universal American is a New York Stock Exchange company with annual revenues of more than $2 billion. Through our family of healthcare companies, we provide health benefits to people covered by Medicare and/or Medicaid. We are dedicated to working collaboratively with healthcare professionals in order to improve the health and well-being of those we serve and reduce healthcare costs.

Well-capitalized and highly entrepreneurial, Universal American has been on the cutting edge of healthcare for more than 21 years. We offer Medicare Advantage plans to people with Medicare. We partner with providers in Accountable Care Organizations that serve people with Original Medicare. And we provide array of healthcare services to states, municipalities, health plans and other entities in the world of Medicaid. In everything we do, we focus on improving the coordination of healthcare through collaboration between payers, providers and patients to achieve the best health outcomes possible.
APS has an exciting opportunity available for a RN Clinical Manager in our Tualatin office. The successful individual will oversee a team of clinical and non-clinical staff and is responsible clinical service delivery in support of the contract. Partnering with the Executive Director and the Medical Director, the Manager assists in strategic development, coordination, integration, monitoring and evaluation of contracted services. The position will require some travel as needed (less than 40 percent is typical).

Responsibilities:
•Ensure compliance with program requirements of all contracted clinical services including oversight of care management functions, quality initiatives and delivery of evidence-based practices.
•Act as a resource for direct reports including but not limited to: protocols, staffing issues, troubleshooting, conflict resolution (internal and external), work-loads/-flows, productivity and personnel issues.
•Review internal and external customer reports for appropriate utilization of services, trends, costs and health outcomes.
•Provide feedback to Executive Director on a timely basis relative to any identified issues and resolution, and to client as requested/required.
•Be directly responsible for recruitment of qualified professionals including orientation and training on processes and systems and continued professional development of existing staff.
•Participate in performance appraisals of on-site and off-site (community based) employees including making recommendations for process improvement, employee development and strategies to achieve contractual outcomes.
•Monitor compliance with URAC and relevant regulatory processes.
•Design and implement departmental policies and procedures including review of relevant workflows and metrics.
•Participate in Provider Outreach and other Business Development activities with client and other local healthcare partners.
•Schedule regular care management and interdepartmental meetings to facilitate cross-functional communication, problem-solving and strategic planning.
•Interact directly with the client (State of Oregon) personnel and is required to meet face to face to discuss open items, plans for the future, Quarterly Reporting, Annual Reporting and any other reporting required by the contract.
•Monitor any changes in the contract to ensure operations remains compliant in all aspects.
•Act as interface when audited internally or externally.
•Conduct many facets of the quality program including the auditing of nurse performance, meeting of metrics, caseloads, etc.
•Assess the use of metrics, setting of standards and the achievement of those metrics.
•Partner with the Medical Director and Executive Director to provide a meaningful population management program designed to bring a strong return on investment for our client(s).

Requirements/Qualifications:
•Bachelor's degree in nursing, health-related field, or healthcare administration (RN is required)
•Master's degree in business, public administration or health care administration strongly preferred
•Active and unrestricted Oregon RN licensure required.
•Seven to ten years of progressive management experience in a healthcare field, including at least four (4) years of team leadership experience
•Previous experience in managed care leading a care coordination and/or disease management program preferred
•Management experience so as to be able to stand in for the Executive Director when needed.
•Experience in population management and the measuring of clinical outcomes is a plus.
•Familiarity with the Oregon healthcare community and resources
•Experience managing through metrics in a performance based culture
•Knowledge of management processes including planning and organizing, financial management, applicable regulations, and human resource development.
•Ability to evaluate reports and pertinent client trends, draw valid conclusions, and exhibit independent judgment in the development and assessment of multiple levels of information.
•Organizational skills and efficiency in prioritizing care management operations.
•Strong verbal and written communication skills.

Universal American Corp. is an Equal Opportunity / Affirmative Action Employer and does not discriminate because of age, color, disability, ethnicity, marital or family status, national origin, race, religion, sex, sexual orientation, military veteran status, or any other characteristic protected by law. We are committed to attracting, retaining and maximizing the performance of a diverse and inclusive workforce.

Required Skills: RN, management, managed care, metrics

Openings: 1

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