Full Job Description
The Sr. Clinical Manager (SCM) is responsible for the management of all clinical functions in the market to ensure consistent, efficient delivery of services throughout the healthcare continuum. The result creates compliance with the clinical model, ensures positive outcomes for patients, and facilitates KPI achievement for the market. The SCM establishes strong relationships with their MA plan or partner hospitals, providers, client peers, and other key market stakeholders.
This position requires input into market-specific strategy and implementation of innovative clinical programs with fidelity to the naviHealth clinical model. This individual assists the Market President in developing strategic direction and creating the annual business plan for the market with consideration to the clinical impact of decisions. The SCM is also responsible for maintaining a positive work environment for our naviHealth colleagues, serving as a communication link to Market Presidents, Corporate Leadership, and Clinical Team Managers and ensuring compliance with all corporate policies and procedures.
Implement and direct naviHealth clinical programs based on the individual needs of clients, identify variation, and propose pilots to Director Clinical Operations (DCO).
Ensure clinically integrated, patient-centric care coordination with a focus on appropriate first PAC setting, appropriate PAC LOS, transitions of care, and readmission avoidance.
Support the concept of being a data-driven organization, relying heavily on analytics and outcome reports to drive the business. Includes daily, weekly, and monthly report review and analysis.
Cultivate a strong internal culture designed around collaboration, feedback, motivation, and accountability. Responsible for clinical operations, quality, and market performance.
Directly supervise a team of Clinical Team Managers (CTM), including weekly one-on-one meetings and regular colleague performance reviews.
Work with CTMs to maximize colleague performance using nH based reports, audits, record reviews, and field-based observations.
Interview, hire, and is ultimately responsible for the competency and compliance of all assigned clinical field staff.
Participate in MMR, reviews results with CTMs, and create action plans for identified issues.
Support the CTM in rounds facilitation, field staff observations, colleague recognition, and coaching when needed.
Conduct weekly team call with all team members.
Work with Market Leadership and Human Capital to determine staffing requirements to support work volume.
May function as a preceptor, mentor, or subject matter expert for new colleagues in the market.
Collaborate with Network Managers to develop business relationships with local providers. Join and contribute to SNF dashboard presentations.
Work directly with the Market President to review market performance and develop/refine the clinical strategy to maximize KPI achievement.
Evaluate performance to benchmarks, goals, and outcomes for all programs as well as high cost, volume and risk conditions.
May make recommendations on reporting and analytic needs of the market.
In conjunction with the Market President, attend and participate in the JOC meetings.
Function as a liaison to the Local Physician Champion (LPC) to manage readmissions and other in market needs.
Develop relationships with client/partner peers at the hospital and plan level.
Monitor Compliance to Implementation Protocols and/or Contract SLA.
Work collaboratively with the Health Services and Utilization Management departments and programs to ensure positive outcomes.
Monitor feedback from member satisfaction surveys and provider feedback and identifies process improvement opportunities.
Ensure compliance with all federal and state regulations, accreditation organizations, and client requests.
Perform other duties and responsibilities as required, assigned, or requested.
Active, unrestricted registered clinical license required – Registered Nurse, Physical Therapist, Occupational Therapist, or Speech Therapist
Master’s degree preferred
5 - 8 years of advanced clinical experience required
5+ years of leadership experience in an inpatient and/or outpatient health care environment
Familiarity with care management, utilization/resource management processes and disease management programs
Experience managing multi-disciplinary care teams, including nurses, therapists, social workers, case managers
Experience in project management and program development/implementation
Strong presentation/public speaking skills
Understanding of the evolving health care market and ability to work collaboratively with physicians
Ability to establish realistic and achievable priorities, goals and objectives
Proficient with Microsoft Office applications including Word, Excel and PowerPoint
Certification in case management (Commission for Case Management Certification (CCMC); Association of Rehabilitation Nurses (ARN) if appropriate) preferred
Knowledge of InterQual and Milliman a plus
Knowledge of NCQA and URAC standards a plus
Clear, concise and persuasive verbal and written communication
Must be able to positively interact with other clinicians, senior management, patients and their families, and all levels of medical and non-medical professionals
Excellent analytic skills
Highest level of ethics and integrity
Proficiency with MS Office Suite
Work Conditions and Physical Requirements
Ability to establish a home office workspace
Ability to manipulate laptop computer (or similar hardware) between office and site settings
Ability to view screen and enter data into a laptop computer (or similar hardware) within a standard time period
Ability to communicate with clients and team members including use of cellular phone or comparable communication device
Ability to sit for an extended time period (1 - 2 hours)
Up to 75% travel
naviHealth is improving the healthcare experience for seniors to live more fulfilling lives. For nearly a decade, naviHealth has been a trusted partner for the nation’s top health plans, health systems, and at-risk physician groups navigating the shift from volume to value. Powered by a predictive technology and decision support platform that provides clinicians and care teams with evidence-based protocols, naviHealth’s high-touch, proven care model fully supports patients from pre-acute through to the home. With naviHealth, patients can enjoy more days at home, and healthcare providers and health plans can significantly reduce costs specific to unnecessary care and readmissions. For more information about naviHealth, visit www.navihealth.com.
Improving the healthcare experience for seniors to live a more fulfilling life
Rooted in respect
Guided by purpose
Devoted to service
Energized by impact
The above statements are intended to describe the general nature and level of work performed by colleagues assigned to this job. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications. naviHealth reserves the right to amend and change responsibilities to meet business and organizational needs as necessary.
naviHealth 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, protected veteran status, or any other protected status under applicable laws and will not be discriminated against on the basis of disability.