Director – Clinical Operations

Director – Clinical Operations

Requirements

• Bachelor’s degree in Nursing, Social Work, Healthcare Management or closely related field with 8+ years’ experience in a healthcare payer organization, or equivalent experience required
• 5+ years’ previous clinical people leadership experience required, preferably in a healthcare payer organization

Responsibilities

• Lead and manage the care management team, including hiring, training, and performance evaluation
• Oversight of clinical leadership within utilization management activities guiding design, evolution, and implementation of the operations related to the clinical review process.
• Develop, implement, and monitor policies, procedures, and service levels
• Assist Medi-Share members in achieving an optimal level of wellness and coordination of their care by helping them identify cost-effective and non-duplicative services while they are in a time of great need and potential crisis
• Assist in educating members regarding the provisions of their Program Guidelines, relative to healthcare, nursing, rehabilitative, and spiritual services
• Provide direction to Care Management staff including, but not limited to staffing, training and communication regarding policy and procedural changes and monitoring and evaluating the quality of all processes
• Perform and/or administer research in ensuring effective, timely responsiveness to Care and Case Management issues; if required, handoff to Chief Medical Officer, providing required research and recommendation summary
• Act as liaison between member and/or provider to bring about resolution when conflicts arise
• Maintain awareness and be alert to member and provider issue trends and escalating concerns, and recommend resolutions
• Oversee the preparation of various telephone scripts
• Update and maintain the policy and procedure manual
• Maintain the High Priority queue in conjunction with fellow Directors and Chief Medical Officer
• Assist in developing projects / policies / procedures and other related issues as required
• Support the strategic vision delineated by the Chief Medical Officer and the Ministry
• In coordination with the Chief Medical Officer, organize and staff the Department in a manner that provides optimal service to the members and membership
• Ensure Department Managers are successful in workforce, quality, and performance management (as elsewhere delineated)
• Define performance expectations of Department Managers
• Define attendance expectations of Department Managers (and the consequences of absenteeism)
• Weekly review weekly performance reports submitted by Department Managers
• Submit monthly performance reports to the Chief Medical Officer of all staff under Director
• Contribute to the exercise and expression of Christian Care Ministry’s Christian beliefs
• All other duties as assigned

Preferred Qualifications

• Master’s or Doctorate degree in Healthcare Administration (MHA), Healthcare Clinical or Operations Management, or similar accredited program preferred
• Health care payer, operations, and change management expertise preferred
• Experience working within a value-based care or a risk-bearing organization preferred
• An understanding of population health, stratification, and working with Care Management preferred