AVP- Clinical Operations

CareCentrix - Remote2.7

Full-time
Overview
As the AVP of Clinical Operations you will have leadership and oversight of clinical operations inclusive of utilization management (UM) for CareCentrix programs in accordance with company policies and procedures. Works with the CareCentrix leadership in Compliance, Account Management, Sales, Product, Clinical Program Develop, Client Services and Business Process Excellence to establish and implement utilization management programs demonstrating best practices. Develops and implements appropriate measures designed to position CareCentrix as an industry leader for excellent clinical outcomes while obtaining optimal financial results for CareCentrix and their customers.

Responsibilities
Leads and oversees Clinical Operations division for CareCentrix.
Assures that UM activities are compliant with regulatory (CMS) and accreditation agency(URAC & NCQA standards, guidelines and client specific requirements.
Participates in internal and external audits of UM activities and outcomes.
Works with the operation’s leadership management team to set priorities and goals for the clinical programs, ensuring utilization performance standards and compliance and quality standards are addressed and met
Works closely with the Sr. Medical Director in ensuring clinical best practices and policies are aligned
Participates in on-going quality assessment/improvement activities. Ensures that information is documented/identified enabling the collection and root cause analysis of data to identify opportunities for improvement related to clinical programs.
Oversees the development/ implementation of performance improvement plans that result in continuous quality improvement and sound clinical judgment
Participates in educating associates, management, customers, payers and physicians in best practices and protocols of care that drive both excellent clinical performance as well as optimizing financial results.
Ensures appropriate staff training for all new clinical initiatives and monitors outcomes/performance
Responsible for mentoring staff involved in clinical programs, providing performance feedback to the team’s management, and promoting consistency in application of program standards.
Assists with the development of reporting strategies and implements plans to ensure all performance outcomes are continuously monitored.
Work with the CCX senior leadership of Product Development to develop, direct and implement best practices for our programs.
Collaborates with Sales, Account Management, Clinical Management, Client Services and Health Plans in the development of clinical program initiatives.
Participates in sales presentations at the local, regional and national levels as required, maintaining CareCentrix as industry leader in the clinical management of home care services.
Qualifications
Bachelor’s degree with a minimum of 8 years’ experience
Clinical experience
Experience with program development desired.
Experience with data analysis and the design and use of clinical measurement systems. Effective verbal/written communication and presentation skills also required.
Experience with leading clinical operation teams and knowledge of accrediting agency standards.
CareCentrix maintains a drug-free workplace in accordance with Florida's Drug Free Workplace Law.

We are an equal opportunity employer. Employment selection and related decisions are made without regard to age, race, color, national origin, religion, sex, disability, sexual orientation, gender identification, or being a qualified disabled veteran or qualified veteran of the Vietnam era or any other category protected by Federal or State law.

We are an equal opportunity employer. Employment selection and related decisions are made without regard to age, race, color, national origin, religion, sex, disability, sexual orientation, gender identification, or being a qualified disabled veteran or qualified veteran of the Vietnam era or any other category protected by Federal or State law.