Clearlink Partners is an industry leading medical management consultancy that is earning the reputation for asking the tough questions, listening well, and building high performing operational and technology teams that deliver superior results. Clearlink Partners offers clinical management services and solutions to both managed care organizations and health systems.
The Interim Director of Utilization and Care Management will be responsible for the strategic direction setting, management, continuous improvement, and maintenance of clinical operations including Inpatient Concurrent Review, Prior Authorization of services, and Care Management for our client in Portland, Oregon. This position will ensure high quality, cost-effective utilization of services by planning, designing, implementing, and evaluating referral services, discharge planning and continuity of care operational programs and processes. Responsible for major change efforts within the scope of clinical management and for the coordination of these efforts in compliance with all corporate policies, provider contracts, and state and federal legislative mandates.
Main Duties & Responsibilities:
- Ability to travel weekly to client site in Portland, Oregon (Monday - Thursday)
- Design Clinical Operations/utilization management programs and processes to meet current strategic needs and to anticipate future strategic changes.
- Develop and oversee inpatient and outpatient utilization management programs to ensure programs provide for (1) cost-effective use of patient care resources and case delivery at the most appropriate level; (2) collaboration with the medical staff on resource utilization issues; and (3) compliance with utilization-related private contracts, all regulating agencies, and applicable federal and state regulatory mandates.
- Direct the Utilization Management functions of the Clinical Services division.
- Develop strategic and operational plans in accordance with organizational and departmental strategic initiatives and goals.
- Develop, recommend and manage department budget.
- Lead, develop, and mentor a management team. Develop staff performance plans, provide regular performance feedback, manage direct reports and perform personnel actions in accordance with policy & procedure. Model and inculcate organizational values.
- Direct the development, implementation, and updating the approval process for the Utilization Management Plan.
- Analyze and monitor quality, cost reimbursement and utilization trends. Identify problem areas, develop strategies, and recommend action plans for resolution.
- Design overall department structure such that a) staffing is appropriate and cost-effective; b) technology use is maximized; and c) staff and operational performance standards are met or exceeded.
- Work closely with senior management and Medical Director to ensure integration of Clinical Operations strategies. Facilitate interdepartmental and interdisciplinary collaboration to ensure efficient coordination of Clinical Operations.
- Collaborate across departments on projects, such as the design, production, and timely distribution of Clinical Support Reports, utilization reports, physician performance reports, and other reports as assigned.
- Salary is negotiable and is commiserate on experience
- Minimum of five years of progressive management experience to include combination of quality improvement, referral management, case management and utilization management required
- Experience working with related legal and regulatory requirements required
- Registered Nurse with current unencumbered Nursing license.
- Advanced degree in business, public health administration, or equivalent education and experience preferred
- Strong computer skills
- Excellent verbal and written communication skills
- Proficient in Microsoft office
- Bachelors of Science Nursing (BSN)
- 5+ years healthcare experience in a health plan (managed care organization.)
- Experience managing a team of registered nurses in a fast paced, time-sensitive environment, demonstrating the ability to motivate to continuously improve their performance with successful outcomes.
Reports To: Vice President of Medical Management
It is Clearlink Partners policy to provide equal employment opportunity to all employees and applicants for employment without regard to race, sex, sexual orientation, color, creed, religion, national origin, age, disability, marital status, parental status, family medical history or genetic information, political affiliation, military service or any other non-merit based factor in accordance with all applicable laws, directives and regulations of federal, state and city entities.
Job Types: Full-time, Contract
Salary: $160,000.00 to $180,000.00 /year
- Clinical Operations Management: 5 years (Required)
- Registered Nurse (RN) (Required)
- Health insurance
- Dental insurance
- Vision insurance
- Retirement plan
- Paid time off
Typical start time:
Typical end time:
- Bi weekly or Twice monthly
This Job Is Ideal for Someone Who Is:
- People-oriented -- enjoys interacting with people and working on group projects
- Adaptable/flexible -- enjoys doing work that requires frequent shifts in direction
- Innovative -- prefers working in unconventional ways or on tasks that require creativity
- High stress tolerance -- thrives in a high-pressure environment
- Autonomous/Independent -- enjoys working with little direction
- Detail-oriented -- would rather focus on the details of work than the bigger picture
- Achievement-oriented -- enjoys taking on challenges, even if they might fail
- Dependable -- more reliable than spontaneous