Director of Clinical Services and Best Practices

Director of Clinical Services and Best Practices

Requirements

• Have license in nursing, behavioral health, medicine, or related healthcare field as an RN, LPRN, or Physician.
• 7 + years’ experience in a licensed clinical role in a healthcare, group benefits insurance, or similar. Minimum 2 years leadership/management experience.
• Have a bachelor or higher in healthcare/business/related field, BSN, MSN, MBA.
• Experience and knowledge of Disability and Absence management/Insurance companies.
• Have extensive clinical knowledge of medical and behavioral health conditions and treatment guidelines.
• Demonstrate knowledge and competency/computer literacy in MS Word, MS excel, MS PowerPoint and analytics.
• Possess effective problem-solving, communication, and leadership skills.
• Exhibit collaboration and team-oriented skills. Have ability to act as an effective liaison across internal departments and with external stakeholders.

Responsibilities

• Managing all aspects of hiring, workload, performance criteria, personnel management, and goal setting for clinical teams. The team consisting of clinician reviewers, behavioral health clinicians, and vocational rehabilitation consultants.
• Focusing on the development of staff by working collaboratively to create and expand upon current goals. Generating opportunities for personal growth amongst the team.
• Leading complex claim discussions to ensure proper execution of clinical consultation and reviews.
• Participating in client meetings and providing clinical and absence management expertise for both external and internal stakeholders.
• Working closely with the CMO to develop reliable reporting metrics. This will include creating KPI’s, quality audit tools, productivity measures, and analyzing medical/behavioral health claim data.
• Creating and developing clinical trainings, products, processes, forms, and best practices. This includes onboarding new hires, establishing clinical documentation protocol, and implementing critical thinking and claim analysis standards.
• Developing standard operating procedures, provider forms, and the ADA clinical review process.
• Providing strategic advice to CMO, Associate Medical Director, and Best Practice leaders while reporting to CMO.
• Overseeing multiple Clinical Operations Managers and is accountable for leading daily oversight of the Clinical Services operations.
• Collaborating with organizational leadership and stakeholders to ensure exceptional clinical services for teams, clients, and employees.

Preferred Qualifications

No preferred qualifications provided.