Director of Clinical Operations - Relocation Offered!

Director of Clinical Operations - Relocation Offered! at MEDSTAR HEALTH summary:

The Director of Clinical Operations is responsible for managing the utilization and case management programs at MedStar Family Choice, ensuring compliance with standards and regulations while promoting quality and cost-effective patient care. This role includes developing departmental goals, overseeing budgets, and collaborating with providers to enhance service delivery and staff training. The Director also participates in strategic planning and community outreach initiatives, acting as a key resource for clinical operations.

General Summary of Position
Responsible for the implementation, integration, and overall operational direction of the utilization management and case management programs within MedStar Family Choice through organizing, directing, assessing, and evaluating a clinical system that manages cost and quality patient care outcomes. Functions as the representative at the system level to assure integration of the case management program and meet the established objective of quality, cost effective outcomes. We recruit, retain, and advance associates with diverse backgrounds, skills, and talents equitably at all levels.

Primary Duties and Responsibilities

• Develops department goals, objectives, policies, procedures, performance and productivity standards. Ensures compliance with policies and procedures and governmental and accreditation regulations. Oversees the development of policies and procedures for the Clinical Operations department. Updates policies at least annually.
• Actively participates with annual strategic planning objectives for MedStar Family Choice. Initiates innovative ideas and programs to improve quality while maintaining or reducing medical expense. Acts as a resource for clinical issues. Ensures that utilization management and case management programs time frames are in compliance with local, federal and NCQA standards.
• Detailed understanding and knowledge of the care management software system and able to identify issues with the software, coordinate training, and coordinate testing for system upgrades. Acts as a resource to staff and outside vendors using the software.
• Responsible for the department operating budget and ensures that department operates within budget. Coordinates with the Medical Director and is responsible for the oversight of the annual audits; ie EQRO, NCQA, etc. Oversees the development of the annual Clinical Operation plan and Clinical Operations appraisal.
• Identifies needs within the network. Works closely with provider relations and the contracting to develop contractual relationships with providers and vendors.
• Oversees the provisions of a range of targeted clinical services and benefits.
• Oversees training program for new staff and is responsible for maintaining an up to date training manual for each area of the Clinical Operations department.
• Participates in multidisciplinary quality service improvement teams. Participates in meetings and on committees and represents the department and hospital in community outreach efforts.
• Provides Clinical Operations department oversight for the Delegated Vendors. Reviews quarterly reports, ensuring adherence to NCQA guidelines and local governmental regulations.
• Provides information for provider education concerning authorization rules, case management objectives and disease management programs. Identifies issues within the network and reports and corrects the issues promptly.
• Provides ongoing individual coaching and support to staff and acts as a resource for clinical, social, utilization and appeal review issues as they relate to the Clinical Operations department. Meets regularly with department members to enhance communication and facilitate implementation and progress towards program objectives. Assists staff members to set personal and educational goals and objectives to enhance their professional development. Responsible for ensuring that the Clinical Operations department is adhering to NCQA guidelines for UM and Complex Case Management programs. Oversees Conducts periodic chart audits to evaluate adherence especially on the must pass" standards for UM, Appeals, and Complex Case Management. Responsible for the analysis and oversight of monthly critical data on LOS, Days per 1000, readmissions, physician denials, denial rates at acute facilities, and other reports as required by MedStar Family Choice Clinical Operations.
• Responsible for the development, evaluation, revision and implementation of programs of case management and care management that adhere to NCQA guidelines and other regulatory standards.
• Responsible to coordinate and conduct studies for the various quality measures required by the District of Columbia regulatory guidelines and NCQA. Evaluates member satisfaction with CM, and makes modifications as necessary to improve satisfaction.
• Selects, trains, orients and assigns department staff. Develops standards of performance, evaluates performance, and conducts performance management planning. Initiates or makes recommendations for personnel actions. Maintains ongoing communication with subordinates to review programs, provide feedback, discuss new developments and exchange information.
• Serves as the Clinical Operations point of contact and expert for all DHCF meetings and encounters.
• Works collaboratively with the Information Systems Team, Data Analyst and report writers to develop reports to meet the department's annual objectives. Uses technology to enhance decision making and effectiveness.
• Develop and execute strategic plans to improve the delivery of health services, aligning with organizational goals and regulatory requirements.

Minimum Qualifications
Education

• Bachelor's degree in Nursing required and
• Master's degree in Nursing preferred

Experience

• 3-4 years Case management experience; 3 years supervisory experience. required and
• 3-4 years Diverse clinical experience in a health services management or administration required
• 1-2 years Experience with Behavioral health preferred
• 1-2 years Clinical Director experience preferred

Licenses and Certifications

• RN - Registered Nurse - State Licensure and/or Compact State Licensure Valid RN license in the District of Columbia Upon Hire required and
• CCM - Certified Case Manager Upon Hire required

Knowledge, Skills, and Abilities

• Verbal and written communication skills.
• Proficient computer skills.

This position has a hiring range of $118,331 - $230,172

Keywords:

Clinical Operations, Utilization Management, Case Management, Healthcare Management, Patient Care, Quality Improvement, NCQA Compliance, Clinical Services, Healthcare Administration, Operational Leadership