Director of Clinical Services - Case Management

SUMMARY The Nursing Managerreports to the Sr. Director and is responsible for the management and oversight of nursing, care management and medical management programs/departments. This position requires a close working relationship with Medical Directors, various departmental Directors and leadership, Providers, Peers and other teammates. ESSENTIAL FUNCTIONS Oversees a team of case managers in office and remotely Partners with interdisciplinary team members in planning the care of patients Leads meetings, determines agenda, action plans and attendees for internal and external meetings. Creates and maintains business work plan to ensure all projects, assignments, metrics, goals and outcomes are met Assures compliance with state and federal regulations/standards. Responsible to ensure patient experience measures are met.  Reviews patient satisfaction surveys and creates improvement plans. Monitors/audits for quality of care, risk/compliance and regulatory issues. Reviews and summarizes all collected, analyzed, and track and trend reports for accuracy before sending out to the appropriate senior leadership. Ability to develop educational tools. Excellent planning and organizational skills. Computer proficient and working ability of Microsoft Office. Knowledge and experience in Quality Assessment and Improvement programs. EDUCATIONAL REQUIREMENTS Associates degree in Nursing required, Bachelor's degreepreferred. Current Nevada RN license. KNOWLEDGE, SKILLS, and ABILITIES Analyzes all nursing and medical management processes. Edits/develops processes, policies, and standard operation procedures for maximum performance, efficiency, and/or quality and educates staff changes/updates. Functions as a nursing resource for the care team, internal and external customers. Resolves complaints and identifies root cause and implements corrective actions. Provider and teammate orientation presentations. Coordinate/conducts monthly/annual audits Creates and conducts training and education for teammates and internal and external customers Ability to administratively manage and coordinate services. Ability to establish and maintain effective working relationships with staff, members, network providers, health plans, and community personnel. Ability to develop, implement and monitor policies to effectively uphold standards of care, policies and procedures. Ability to train and develop staff. Contributes to and supports the corporation's quality initiatives by planning, communicating, and encouraging team and individual contributions toward the corporation's quality improvement efforts. Develops, oversees, and coordinates strategies for ensuring the delivery of care in the most appropriate setting, including managing and coordinating resources to create the most effective care and treatment of our patients.  Works collaboratively between Operations and Nursing to enhance outcomes and to ensure that operational and medical functions coincide to create a cohesive work environment and work flow. Responsible for the quality and continuous improvement within the job scope. R0060900
Salary Range: NA
Minimum Qualification
Not Specified years

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