Clinical Operations, Manager - RN, NP, PA or DO - Hybrid (within Oregon)

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

Acentra seeks a Clinical Operations Manager - RN, NP, PA, or DO - Hybrid (within Oregon) to join our growing team.

Job Summary:

The Clinical Operations Manager - RN, NP, PA or DO - Hybrid (within Oregon) is responsible for remote (work from home) and 20-25% field based visits in the community:

• Supervising and managing the day-to-day activities of the assigned case management and utilization review teams, including interdisciplinary team integration and field-based services.
• Mentoring, coaching, and training team members for all clinical processes to ensure quality and contract deliverables are met.
• Using independent judgment, utilizing clinical knowledge and competence, communication skills, problem-solving, and conflict resolution to effectively ensure optimal client outcomes, considering client requirements.
• Working effectively with all team members internally and externally.
• Oversight of call center and nurse advise triage line.
• Supporting the interdisciplinary team with the underlying objectives of maximizing enrollment, enhancing the quality of clinical outcomes (including participant satisfaction), ensuring contractual, regulatory, and accreditation compliance, and providing timely and accurate data and communications.

** Required Work Hours: Monday - Friday from 8:00 AM - 5:00 PM Pacific. **

** Occasionally, work may be required in the evenings and on weekends. **

Job Responsibilities:

• Supervises, mentors, coaches, trains, and develops the case review and utilization review teams within the clinical domain of case review and dispute resolution while ensuring the team's high clinical expertise and performance, embracing a compassionate leadership approach throughout the case review process.
• Supervises, mentors, coaches, trains, and develops the case management team in the care coordination/case management of participants; ensures a high level of clinical knowledge and performance by the clinical team.
• Fosters a caring philosophy in leadership and all aspects of the case management process.
• Effectively manages team assignments, evaluating and addressing workload to align with departmental demands and contractual obligations. Adjusts staff assignments and tasks to enhance member-related results and client satisfaction.
• Applies a comprehensive knowledge of case management, care coordination, and caring concepts to all aspects of clinical assignments.
• Identifies the ongoing educational needs of case review staff. Develops and executes plans for orientation and continuous learning to enhance team competencies.
• Performs quality monitoring activities, including identifying areas for improvement for individual team members, processes, and quality improvement initiatives.
• Ensures compliance with regulatory and accreditation (URAC) standards and contractual service level agreements.
• Participates in developing, implementing, evaluating, and revising clinical pathways/assessments and care plans, and other case management tools that specifically support case management programs.
• Maintains open communication with all appropriate parties and facilitates communication to/between members of the care team; ensures accurate and timely documentation and reporting.
• Maintains strict standards for client confidentiality and client-related information; complies with all organizational, state, and federal regulations and policies on confidentially.
• Performs other duties related to case management supervision functions as needed.

The above list of accountabilities is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary from time to time.

Required Qualifications/Experience:

The selected candidate must possess one of the following Active, Unrestricted, Unencumbered Licensures in the State of Oregon:

• Registered Nurse (RN) AND the ability to obtain Nebraska RN state licensing.
• Nurse Practitioner (NP), Physician's Assistant (PA) OR Doctor of Osteopathic Medicine (DO) licensure in Oregon.
• Master's degree in a health-related field.
• 10+ years of clinical experience in a medical or behavioral health setting.
• 5+ years direct team management and supervision.
• 3+ years of Case Management and Utilization Management (e.g., Utilization Review, Clinical Review, or Prior Authorization) experience.
• 3+ years of exceptional supervisory, organizational, and time management skills, with the ability to handle multiple competing contractual and team-related priorities.
• 1+ years of knowledge of clinical aspects of nursing/case management/utilization review management.
• 1+ years of telephonic case management and/or triage experience.
• 1+ years of experience with field-based work: integration or supervision or oversight.
• 1+ years of experience in quality management, including involvement in projects, reporting outcomes, or other Quality Improvement Programs (QIP).
• Ability to organize and manage tasks efficiently with minimal supervision.
• Computer proficiency in Microsoft Office and other software programs and the ability to enter and retrieve data from relevant computer systems.
• Excellent verbal and written communication skills; excellent interpersonal communication and negotiation skills.
• Required to pursue ongoing education, certification, and self-development to remain current with case management standards.
• Maintain URAC-recognized certification.
• Demonstrate the ability to be organized and efficient in prioritizing and managing assignments with minimal oversight and direction.
• Understand the importance of instilling a caring philosophy in all aspects of the case management process.
• Ability to achieve Certification in Case Management (CCM) during first year of obtaining this position.
• Previous workload management experience.

Preferred Qualifications/Experience:

• Ph.D. in a health-related field.
• 1+ years of experience in multiple chronic disease programs.
• Certification in Case Management (CCM).
• CLSS/CLAS equity training familiarity/experience.
• Inter Rater Reliability Management experience.
• URAC or NCQA accreditation process experience.
• Analytical, reporting, and data management skills.
• Emergency or evacuation management experience.
• Previous contractual and client relationship management experience.

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Why us?

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

We do this through our people.

You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

Thank You!

We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search!

~ The Acentra Health Talent Acquisition Team

Visit us at Acentra Health

EEO AA M/F/Vet/Disability

Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.

Benefits

Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

Compensation

The pay range for this position is listed below.

"Based on our compensation philosophy, an applicant's position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level."