Clinical Manager: Catholic Health Care System (CHCS) (HQTRS)
   Clinical Manager Overview: Assists the Director in the development, coordination, implementation, monitoring and evaluation of quality and utilization activities related to outcomes management in accordance with ArchCare and State and Federal mandates and regulations Responsibilities: - Works with Director to recruit nurse practitioners.
- Develops and provides orientation to new nurse practitioners and routine training including operational policies and procedures, workflows, internet resources to existing nurse practitioner staff.
- Manage and develop nurse practitioner staff by setting goals and providing daily feedback, re-direction and coaching.
- Serves as a resource to support high-quality Model of Care, member advocacy, provider education, nursing home in-service, benefit determinations and utilization analysis.
- Conducts monthly team meetings with all NPs that include agenda and minutes to share program results including quality and utilization metrics,
- Develop and facilitate collaborative relationships with other members of the health services team, as well as the broader site staff, to serve on committees, develop best practices, and facilitate communication and to guide the relationship of the Care Manager and the NP’s.
- Ensures NP compliance w ArchCare policies & procedures including authorization processes and super-bills.
- Evaluates the activities of NP staff to audit and improve performance:
- Coordinates and reviews with the Manager of Quality Management, all routine quality audits, all incidents and grievances and individual cases, including sentinel events, to ensure that process standards are met, educational opportunities are addressed, and successful outcomes are achieved.
- Review cases daily with NP team members to verify that care planning efforts are focused and prioritized.
- Based on this daily review of cases, communicates with the Medical Director, on a daily basis, about all potential hospitalizations, actual hospitalizations, potential transfers to nursing homes and actual transfers to nursing homes from hospitals.
- Evaluates the consistency, thoroughness, quality and compliance of processes documented in the clinical medical record (computer system).
Qualifications: Bachelor’s degree, Nurse Practitioner, preferably Geriatric Nurse Practitioner. Three - five (3-5) years’ supervisory management experience, with a managed care or insurance company. EOE |
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