Clinical Manager - UM PAC

Post-Acute Care (PAC) Program is an end-to-end post-acute offering that manages up to 90-day episodes of care, beginning prior to the patient’s discharge from the hospital, or for elective surgical cases, outreach begins prior to hospitalization. The program identifies the likely best site-of-care for the patient, manages length of stay (LOS) if a Skilled Nursing Facility (SNF), Inpatient Rehab Facility (IRF) and/or Long Term Acute Care Hospital LTCH is appropriate, and reduces hospital readmissions through effective discharge planning.

This position is responsible for the day-to-day operations of the Post-Acute Program and provides team leadership and guidance regarding patient centered interventions in post-acute facilities. This position leads their team of PAC Nurses in driving the desired clinical outcomes across Long Term Acute Care Hospital, Inpatient Rehab Facilities and Skilled Nursing Facilities. The Clinical Manager also collaborates with case management leadership and physicians as appropriate to achieve the patient centered goals. In addition, this position will directly interact as needed with referral sources to facilitate communications, answer questions and resolve problems. This role reports to the Director of UM PAC.

In this Job, you will: 

• Be responsible for the day to day operations of the Post-Acute Care (PAC) Program and provide PAC Nurse team leadership across one or multiple geographic markets.
• Work in collaboration with Learning and Development (L&D) to develop training tools to support introduction of new and existing clinical team members being assigned to facilities. Participate in staff development, ensuring department activities are consistent with CareCentrix policies and procedures and contractual agreements.
• Assist the Post-Acute Care Program with clinical oversight.
• Assist Product Portfolio Management team in defining operational processes/procedures and implements standardized operational processes to ensure compliance with CareCentrix policies, legal requirements and regulatory mandates.
• Oversee and manage all daily team activities and assigns tasks and responsibilities to appropriate team members.
• Monitor performance and productivity of team and individual members and take appropriate action to ensure guidelines and goals of the department are met.
• Work in partnership with the Medical Director, functions as the lead clinical resource to Post Acute team. Audit cases and interventions to monitor outcomes, track/trend results and identify opportunities for process improvement.
• Monitor department reports and provide input for team and individual staff improvement opportunities that are in accordance with department and company goals.
• Work with Clinical Management to implement best practices for utilization and authorization management of selected services and contributes to performance and process improvement activities.
• Perform all duties in a management role. Interact with all CareCentrix departments, CareCentrix staff, providers, referral sources and health plans to facilitate communications, answer questions, and resolve problems.
• Participate in implementing / maintaining operational processes to ensure compliance to Company policies, legal requirements and regulatory mandates.
• Participate in on-going CareCentrix quality assessment and improvement activities as assigned, and documents information enabling data collection and root cause analysis needed to identify opportunities for improvement.
• Interact with health plan clinical partners, hospital and skill nursing facility staff, home health agencies and physicians to insure effective education and communication of the tenets of Post-Acute Care Program.
• Encourage/foster and environment of teamwork, communication, collaboration and readiness for change.
• Participate in special projects and performs other duties as assigned.
• Travel about 10% for leadership meetings or as requested.

You should get in touch if:

• You have excellent negotiation, communication, problem solving and decision-making skills. (Required).
• You hold a Bachelor of Science in Nursing (BSN) or Associates of Science in Nursing and active unrestricted Registered Nurse licensure.
• You possess a minimum of five years' experience with thorough knowledge of managed care regulations, utilization management, case management, clinical coaching, re-engineering processes, contract terms/stipulations, capitation requirements and governmental home health agency regulations required.
• You have previous management and leadership experience strongly desired.
• You have knowledge of State and Federal regulations in regard to Utilization Management and accreditation standards i.e. URAC, NCQA (Required).
• You have previous Case/Care Management experience (Preferred).
• You possess a Case Management Certification (CCM) a plus.

What we offer:

• Salary Range: $100000 - $120000 / year plus corporate bonus incentives
• Full range of benefits including Health, Dental and Vision with HSA Employer Contributions and Dependent Care FSA Employer Match.
• Generous PTO, 401K Savings Plan, Paid Parental Leave, free on-demand Virtual Fitness Training and more.
• Advancement opportunities, professional skills training, and tuition Reimbursement
• Great culture with a sense of community.

CareCentrix maintains a drug-free workplace.

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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.

CareCentrix accepts applications on an ongoing basis until a candidate is identified.