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RN National Clinical Director

RN National Clinical Director

Job Description

At Collaborative Health Systems, we are passionate about changing behaviors of all constituents in the healthcare system to improve health, optimize clinical quality, and reduce associated costs. Our mission is quite simply to improve the health of those we serve.

You will have an exciting opportunity to be part of the implementation and operation of Accountable Care Organizations (ACOs) aimed at increasing care coordination, improving quality of care and reducing costs for Medicare members. ACOs are designed to achieve the three part aim of better care, improved health and lower per capita costs. Improved health will be accomplished through prevention and chronic care management. The aim of the ACO is intended to reduce the trend of cost increases associated with the Medicare fee for service population.

The RN National Clinical Director functions as Clinical National leadership for the development organization and management of CHS ACO Care Coordination and its multiple functions within the multi-state area. The Director will be required to travel 50% of the time. This position will lead and guide Care Coordination team in meeting the goals and mission of the ACO:

ACO Mission – The Triple Aim
• Better Care in a safe environment, equitable to all who seek it, and available when needed;
• Improved Health accomplished through prevention and chronic care management;
• Lower Per Capita Costs intended to reduce the trend of cost increases associated with the Medicare FFS population.

• Provides leadership to and is accountable for the development, organization, management and performance of the ACO’s.
• Develops and supports implementation of overall strategic plan in order to achieve ACO financial, organizational and quality in patients’ care goals.
• Ensures the development and establishment of necessary operational infrastructure to support the CC/QI program within established benchmarks and model requirements.
• Oversees ACO’s compliance and quality management efforts to support the ACO objectives.
• Promotes collaboration with ACO participants, Medical Directors, community physicians, hospital leaders, providers and other vendors regarding care coordination and access to quality, cost effective health care services.
• Ensures education of CHS clinical management, care coordination staff, patients, families, providers and local community regarding healthcare quality initiatives.
• Interacts with Provider Relations in a coordinated approach to support each department’s initiatives, while communicating consistent messages in all interactions.
• Monitors and reports on utilization, quality and financials, to identify changes in access patterns, trends or overall quality in the health care of the ACO patients.
• Adopts and shares best practices with clinical leaders within the ACO.
• Identifies, hires, trains, and evaluates the ACO Care Coordination management team and clinical and non-clinical staff.
• Prepares and submits reports to upper management as requested.
• Ensures regular team meetings are conducted for communication and feedback, staff training and development, sharing of program results, and collaborative problem solving.
• Complies with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable, and defined in the Universal American Corporate and department policies.
• And all other duties assigned by the manager and/or supervisor.

Required Skills:
• Professional verbal and written communication skills, with the ability to clearly articulate thoughts and ideas
• Organizational skills with the ability to handle multiple tasks and/or projects at one time
• Customer service skills with the ability to interact professionally and effectively with providers, third party payers, physicians, and staff from all departments within and outside the Company
• Analytical and interpretation skills including departmental, utilization, financial and operations data
• Decision-making skills with the ability to investigate and weigh alternatives and select the course of action that provides the greatest benefit to the organization
• Creative thinking skills with the ability to ask the needed bigger-picture questions that lead to process and team improvements
• Time management skills with the ability to prioritize and schedule daily activities for the most efficient use of time
• Problem solving skills with the ability to look for root causes and implementable, workable solutions
• Interpersonal skills with the ability to work in a fast-paced environment and participate as an independent contributor with little supervision or as an active team member depending on the situation and needs
• Leadership skills with the ability to empower, engage, motivate, evaluate and manage team members individually and as a group
• Must have a track record of producing work that is highly accurate, demonstrates attention to detail, and reflects well on the organization

Required Experience:
• Minimum 5 years’ clinical experience in a hospital setting
• Minimum 10 years’ previous supervisory experience that includes Quality Assurance and Case Management and Utilization Management experience
• Minimum 5 years of experience in a managed care setting with in-depth knowledge of the industry
• Experience creating budgets and financial plans
• Personal computer experience should include working with Microsoft Word, Excel, PowerPoint and Outlook at the intermediate level at a minimum

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.

Job Requirements

Please refer to the Job Description for the qualifications.

Job Snapshot

Employment Type Full-Time
Job Type Health Care
Education Not Specified
Experience Not Specified
Manages Others Not Specified
Industry Healthcare - Health Services, Managed Care
Required Travel Not Specified
Job ID 4942
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RN National Clinical Director

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