Clinical Manager - UM Sleep & Home Health

The UM Clinical Manager oversees the assigned UM teams and is responsible for the initial clinical review process for the agreed-upon time. The department's activities include serving as a resource for the utilization management program and participating in clinical guideline applications and interpretation. Will assist with clinical data collection, analysis, and reporting to support ongoing UM Clinical Operations in liaison with the Operations Oversight, Quality & Process Excellence, and Compliance teams to ensure service requirements are met, intervene when service levels are at risk, provide appropriate issue resolution, and/or escalation when necessary, assuring timely letter generation and mailing, and coordinating, as appropriate, with the preparation for internal and external audits. The UM Clinical Manager will provide UM team members with initial or continuing education and training, performance monitoring, and issue intervention and resolution to ensure department goals are met. The UM Clinical Manager will collaborate with internal partners to ensure turnaround times comply with client, regulatory, mandate, and accrediting agency standards, and CareCentrix internal guidelines and policies. Works under general supervision.

In this Job, you will:

• Define and implement quantitative performance measures to establish performance objectives and continuously raise performance standards.
• Participates in implementing/maintaining operational processes to promote compliance with Company policies, legal requirements, and regulatory mandates.
• Effectively monitor the performance and productivity of the assigned teams, team leads, and supervisors, and take appropriate action to ensure guidelines and goals of the department are met, including performance reviews.
• Participate in the development of individual associates through coaching and mentoring. Provides education and training, as needed.
• Ensure new hire orientations are conducted and assesses the effectiveness of orientation programs. Administers CareCentrix employee terminations and ensures the appropriate paperwork is processed, conducts exit interviews, and monitors/tracks reasons for termination.
• Perform interviews as needed to ensure that a high-performing team is recruited and developed to achieve priorities.
• Effectively manage UM clinical activities as assigned, including but not limited to data collection, analysis, interpretation, monitoring, and reporting.
• Track and monitor turnaround times and SLAs, and complete issue research and resolution when necessary to ensure all requirements are met.
• Implement and maintain standardized operations processes to ensure compliance with CareCentrix policies, client requirements, legal requirements, and regulatory or state mandates.
• Design and implement strategies and best practices that drive process and performance improvements.
• Partner with Operations Leadership, Clinical Management, and the Quality Department to support clinical and utilization management goals and objectives.
• Monitor, maintain, and promote compliance in alignment with client policy guideline criteria and utilization guidelines, internal clinical operations policies, and all internal CareCentrix policies.
• Participate in internal and external audit reviews, perform research for resolution, and make necessary departmental changes as required under the guidance of Ops Oversight and Compliance.
• Conduct regular staff meetings to ensure the needs of patients/clients/families, providers, payers, and referral sources are met.
• Attend/participate in staff development programs and obtains continuing education as required by company policy and licensing bodies. Interacts with referral sources to facilitate communications, answer questions, and resolve problems.

This is the job for you if:

• You possess excellent communication (verbal/written), organizational and interpersonal skills.
• You can manage multiple tasks, be detail oriented, be responsive, and demonstrate independent thought and critical thinking.
• You have critical thinking and the ability to analyze data to understand an expected outcome
• You have proven abilities to effectively manage and prioritize tasks and thrive in a fast-paced environment.

You should get in touch if:

• You have a clear and active Registered Nurse/LPN/LVN (based on allowable state practice act) license in any state(s) or jurisdiction in the United States is required.
• You possess a minimum of two years of Supervisory experience.
• You have a minimum of two years of experience with thorough knowledge of healthcare delivery systems and managed care regulations, utilization management, case management, process improvement, re-engineering processes, contract terms/stipulations, and government regulations are also required.
• You are a competent and are experienced with Utilization Management and Regulatory and Accrediting agency standards.

What we offer:

• 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.

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.

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