United States onlyFollowing a 2022 merger of CNSI and Kepro, Acentra Health combines clinical services, technology solutions, and data analytics to accelerate better health outcomes. This is a great time to join our team of passionate individuals working together to pursue the most effective solutions to today’s complex healthcare challenges. Our culture is fueled by passion and driven by purpose.
As the Registered Nurse Clinical Manager, your role is pivotal in leading and overseeing the day-to-day operations of the designated Case Review Teams. You will embody the spirit of mentorship, coaching, and training, uplifting team members to excel in the case review process, thereby assuring the highest standards of quality and meeting contractual obligations. Your role demands the application of independent judgment, leveraging your profound clinical expertise, communication prowess, and problem-solving skills to navigate complex scenarios. This ensures the achievement of optimal outcomes for our clients, in alignment with both payer and client specifications.
You will be the cornerstone of collaboration, working synergistically with healthcare team members across the board, both internally and externally. Your leadership is critical in supporting our interdisciplinary team, with a relentless focus on adhering to contractual, regulatory, and accreditation frameworks. Your commitment to delivering accurate and timely data, coupled with effective communication, will drive our mission forward, ensuring excellence in patient care and operational success.
This position requires the selected candidate to work Monday - Friday from 9:00 AM - 5:30 PM Eastern Standard Time. Some on call time may be required in the evenings and on weekends.
Job Responsibilities:
- Leadership and Development: You will supervise, mentor, coach, and develop the case review team within the clinical domain of case review and dispute resolution. It's crucial to ensure the team's high clinical expertise and performance, embracing a compassionate leadership approach throughout the case review process.
- Team and Workload Management: Manage team assignments effectively, evaluating and addressing workload to align with departmental demands and contractual obligations. Your role involves measuring outcomes and making personnel decisions as needed, applying your in-depth knowledge of case review principles.
- Staff Development: In collaboration with leadership, identify the ongoing educational needs of case review staff. Develop and execute plans for orientation and continuous learning to enhance team competencies.
- Quality and Compliance: Lead quality monitoring activities to pinpoint areas for improvement in team performance, processes, and overall quality initiatives. Ensure adherence to regulatory standards, accreditation requirements, and contractual agreements.
- Program Support: Engage in the development, evaluation, and revision of case review tools and methodologies to bolster the effectiveness of case review programs.
- Communication: Maintain open lines of communication with all relevant parties, promoting smooth information flow within the care team. Ensure documentation and reporting are both accurate and timely.
- Confidentiality and Compliance: Uphold the highest standards of client confidentiality and adhere strictly to all organizational, state, and federal privacy regulations.
- Contract Management: Actively participate in contract management activities and oversee the fulfillment of contract administration responsibilities.
- This list of responsibilities is not exhaustive and may be expanded to include other tasks as deemed necessary by management.
Required Qualifications, Knowledge, Skills, and Experience:
- Must possess an active, unrestricted RN license.
- A Bachelor’s degree in nursing or a related field is preferred.
- Commitment to ongoing education, certification, and self-improvement is essential to stay abreast of current case review standards.
- A minimum of 5 years of clinical experience in a medical setting is required.
- Experience in quality management, including involvement in projects, reporting outcomes, or other Quality Improvement Programs (QIP).
- Demonstrated experience in case review processes adhering to evidence-based practice standards.
- Familiarity with the No Surprises Act and Dispute Resolution processes.
- Proven workload and client management experience.
- Strong leadership and supervisory skills with a recommendation for Independent Dispute Resolution expertise.
- Exceptional skills in fostering team unity and motivation.
- Outstanding verbal and written communication skills, complemented by superb interpersonal and negotiation abilities.
- Capacity to employ critical thinking for effective decision-making and guidance.
- An understanding of the significance of incorporating a caring philosophy throughout the case review process.
- Proficient in analytical, reporting, and data management skills.
- Exceptional organizational and time management skills with the ability to handle multiple priorities.
- Demonstrated capability to organize and manage tasks efficiently with minimal supervision.
- Competence in Microsoft Office and other relevant software programs, alongside adeptness in data entry and retrieval from various computer systems.
Singularly Focused. Mission Driven.
Accelerating Better Outcomes is our Mantra! We are mission-driven to innovate health solutions that deliver maximum value and impact.
Why us?
We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.
We do this through our people.
You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.
Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.
Compensation
The compensation for this role is $90,000 to $96,000 annual salary. Based on our compensation program, an applicant’s position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level.
EOE AA M/F/Vet/Disability
Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.
We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search.
