DIRECTOR, CLINICAL SERVICES -SUMMARY
Overall responsibility for Clinical Management (UM Coordination). Participates in the development, implementation, and monitoring of all patient care programs including Utilization Management.
MUST HAVE THE BELOW MINIMUM QUALIFICATIONS TO BE CONSIDERED FOR THE POSITION:
- Graduate of an accredited school of nursing with a minimum of an Associates or Bachelor’s degree.
- Current nursing license (and advanced practice license if applicable) in the state of employment/practice.
- Minimum of five years’ infertility experience preferred.
- Minimum of two years’ experience managing staff preferred
- Minimum one-year experience in Utilization Management/Review preferred.
DIRECTOR, CLINICAL SERVICES - POSITION REQUIREMENTS
- Leads the clinical activities of the utilization management team by direct supervision of Care Managers, leads and administrative staff.
- Conducts clinical peer reviews of UM decision making of Care Managers.
- Interacts with patients and providers associated with the active management of the patient’s care, when necessary or requested due to escalation, to ensure patient needs, treatment, and/or proper protocol is handled correctly.
- Prepares reports for and participates in monthly Utilization Management Committee meetings.
- Participates in reviews of all denials and assesses whether WIN protocols and procedures as well as state mandates were followed in such a way as to assure good medical care was provided.
- In the absence of the VP, Clinical Services & QA, may assist sales team with clinical aspect of client meetings and calls acting as subject-matter expert for best practices, evidence-based guidelines, and current trends in fertility management.
- Collaborates closely with VP, Clinical Services & QA to ensure all initiatives are aligned to WIN’s strategic goals and are integrated throughout the company.
- Participates in process improvement and development to make recommendations within the scope of accountability
- Maintains current knowledge of women’s health issues including new trends in technology, intervention, and prevention strategies.
- Attends continuing education programs to augment clinical and administrative knowledge base.
DIRECTOR, CLINICAL SERVICES -SUPERVISORY RESPONSIBILITIES
Manages the activities of Clinical Services team, including Care Managers, team leads and administrative staff. Responsible for overall direction and evaluation of the clinical aspects of Care Management. Responsibilities including interviewing, hiring, and training employees; planning, assigning, and directing work.
DIRECTOR, CLINICAL SERVICES -KNOWLEDGE, SKILLS AND ABILITIES
- Management experience including fiscal and administrative background.
- Excellent communication skills both written and verbal.
Job Type: Full-time
- Obgyn: 5 years (Preferred)
- Management: 5 years (Required)
- Infertility Care: 5 years (Preferred)
- Utilization Management: 5 years (Required)
- Greenwich, CT (Preferred)