About the role
Position Summary The Regional Manager Clinical Services will be responsible for planning, directing, and overseeing the performance of a team of assigned Provider and Member facing staff. The position will oversee the administrative, clinical, and quality activities related to building strong provider and member engagement and health outcomes.
Responsibilities
- Function as ambassador for organization with all internal and external customers - Collaborate as needed with team to help engage providers and members and serve as escalation point for difficult practices and/or members - Implement organization policies, procedures, workflows, and action plans to drive team performance - Ensure collaboration and communication among multi-disciplinary teams to ensure they are coordinated in working toward maximum customer engagement and improved member outcomes - Monitor Key Performance Indicators (KPIs) to identify trends and areas of opportunity that will guide regional strategy; Develop action plans and/or remediation strategies to address areas of opportunity - Develop, monitor, and report on team performance and productivity - Troubleshoot technical issues as needed - Promote an environment of continuous improvement through on-going team audits, provider practice visits, and monitoring of member calls to identify gaps in teams’ skills and competencies; Work to develop ongoing team education to address areas of opportunity - Develop, coach, and mentor team members to achieve company, department, and individual goals - Conduct yearly performance evaluations and provide constructive feedback to redirect team members with a positive discipline approach - Maintain team performance according to National Committee for Quality Assurance (NCQA) standards including but not limited to appropriate provider and member documentation - Comply with HIPAA privacy laws, all other federal and local regulations, and company security policies - Provide recommendations to the leadership regarding necessary operational adjustments needed to ensure organizational objectives and goals are met - Perform other related duties as assigned
Requirements
- Bachelor's degree in healthcare or related field required; master’s degree preferred - Active, unrestricted RN license required - Minimum of 3 years progressive supervisory and/or management experience required - 5 years of progressive experience in healthcare services, clinical operations, quality, or care management required - 5 years of experience in closure of care gaps or care coordination preferred - Prior experience building and managing relationships with health care providers or patients preferred - Proof of valid and unrestricted driver’s license required - Must be able to successfully comply with the credentialing process - Must be located in PST or MST time zone
Skills
- Excellent verbal, written and presentation skills - People skills to develop and maintain strong internal and external relationships - Ability to multitask, prioritize, and create solutions in a challenging environment - Demonstrated leadership skills and ability to create and maintain a positive work environment - Strong critical thinking and analytical skills - Ability to foster strong employee engagement among the team - Must be proficient in Microsoft Office: Outlook, Word, Excel, PowerPoint
Travel Moderate Travel, up to 20%
#LI-Hybrid
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