19 days old

Clinical Manager

Keystone Peer Review Organization, Inc.
West Linn, OR 97068
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  • Job Code
    CLINI02276-00001



KEPRO is a rapidly growing national quality improvement and care management organization. We work to ensure that over 20 million people receive the right care, at the right time, in the right setting.KEPRO is seeking resumes for a highly experienced professional.



Accountabilities



  • Oversee, coordinate, and monitor all care coordination and integration services.

  • Provides supervision to RN Case Manager field staff engaging clients classified by acuity and ensuring care coordination is provided through outreach and health assessments

  • Ensure adequate staffing and contractual service levels are adhered to by implementing and monitoring clinical staff productivity and performance indicators. Maintains effective team member relations.

  • Leads team members in improving utilization management skills, creativity, and problem solving.

  • In conjunction with the medical director, provides clinical Coordination of Prior Authorization for applied behavioral Analysis, Administrative Reviews and Third Party hospital appeals

  • Work with management team to develop and enhance the operational structure including skill set requirements, gap analysis, and training using workforce planning.

  • Manages and completes assigned work plan objectives and projects on a timely basis.

  • Provide advice and assistance to leaders in the planning, implementation, and evaluation of modifications to existing operations, systems, and procedures. Collaborate with leadership in the development of new and enhanced products and services.

  • Represents the clinical department by participating on Quality Improvement committees, task forces, work groups, and multidisciplinary teams. Maintains professional relationships with provider community and external customers and identifies opportunities for improvement.

  • Participates in the development of policies and oversees clinical staff activities to ensure compliance with regulatory and accrediting standards.

  • Provides reports of compliance and other Utilization Management activities.

The list of accountabilities is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary from time to time.



Qualifications



  • Master of Health Administration (MHA), MBA in Healthcare, Master of Public Health (MPH), or a similar or level higher degree.

  • Non-restricted, clear RN license required.

Knowledge, Skills, Abilities



  • Demonstrated proficiency in MS Office applications.

  • Ability to maintain a positive attitude and contribute both as an individual and a team member to achieve the goals of the department.

  • Ability to professionally respond to change and handle multiple and changing priorities with sometimes conflicting deadlines.

Experience



  • 5+ years of clinical experience performing the role of a clinical operations Manager

  • Minimum of 3 years experience in UM/UR and Appeals required.

  • Experience with State Medicaid programs, strongly preferred.

  • Minimum 3 years of staff/workload management experience required.

  • Experience with a start-up, strongly preferred.

  • Experience in services such as DME, Dental, Medical/Surgical, Psych, BH, Home Health etc., strongly preferred.

Mental and Physical Requirements



The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations will be made as required by law in an attempt to enable an individual with a disability to perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit for prolonged periods of time; key and/or control objects; interact extensively with internal and external customers; occasionally lift and/or move objects weighing up to 10 pounds; and occasionally travel within the state.



KEPRO offers challenging careers, excellent benefits and opportunities for advancement. For consideration, please submit resume and cover letter with salary requirements.Only those candidates identified for an interview will be contacted.No Phone Calls Please.Visit our website at www.KEPRO.com for more information on the KEPRO Family of Companies.



EOE AA M/F/Vet/Disability



KEPRO is an E-Verify employer. E-Verify is an internet based system operated by the Department of Homeland Security (DHS) in partnership with the Social Security Administration (SSA) that allows participating employers to electronically verify the employment eligibility of their newly hired employees in the United States.



Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities



The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractors legal duty to furnish information.



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Posted: 2019-10-31 Expires: 2019-11-29

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Clinical Manager

Keystone Peer Review Organization, Inc.
West Linn, OR 97068

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