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Provider Partners is an Institutionalized Special Needs Plan (ISNP) which is a Medicare Advantage program that provides primary and preventative care via a Nurse Practitioner and Registered Nurse Care Coordinator dyad to members at partnering skilled nursing facilities (SNF’s). The objective of the program is to provide excellent, patient-centered, collaborative medical care that allows the members to be treated in their own homes (SNF’s) ultimately reducing unnecessary hospitalizations, duplication of testing, and fragmentation of care.
The Provider Partners Clinical Management (PPCM) Clinical Operations Manager (COM) is responsible for providing local market clinical leadership and oversight for the health plan. Under the general direction of the Director of Clinical Operations, the COM coordinates care between the partnering SNF’s clinical leadership, the SNF interdisciplinary care team, and the PPCM clinical team to ensure delivery of excellent, compassionate and personalized health care as the Model of Care (MOC) promises.
The COM has direct oversight of the day-to-day clinical operations of the market, including supporting quality health care delivery, clinical proficiencies, utilization management, and business development while adhering to the PPCM Model of Care and other regulatory/accreditation guidelines. The PPCM medical model also provides additional concierge services of which the COM in conjunction with the RNCC Manager oversights as well. Additionally, the Clinical Operations Manager is directly responsible for management and development of the PPCM clinical team which consists of Senior Clinicians, Nurse Practitioners (NPs) and Registered Nurse Care Coordinators (RNCC’s).
Having a strong ambassador element for the health plan, this role requires time in the field collaborating and coordinating care with the clinical leadership and interdisciplinary care teams at partnered and potential skilled nursing facilities.
ESSENTIAL RESPONSIBILITIES
- Serve as local clinical ambassador for the program providing clinical and strategic leadership to ensure the provision of excellent and efficient quality of care in accordance with the PPCM MOC
- Track progress, identify barriers, and implement strategies to meet established market utilization and quality metrics.
- Maintain knowledge and achieve compliance with federal, state and local regulatory requirements, licensure, accreditation requirements
- Design, develop, and implement strategic initiatives, educational programs, policies and procedures for efficient clinical operations and achievement of financial and quality metrics
- Assist in maintaining financial objectives and cost improvement programs for the assigned market
- Support new market development efforts with partnering entities
- Collaborate with PPHP/PPCM senior leadership to drive performance and establish innovation within the company
- Interact with attending physicians and skilled nursing facility medical directors to establish successful working relationships for the health plan
- Support corporate functions such as NP auditing, documentation management, HEDIS/Stars quality measures, and policies & procedures.
- Manage and report utilization results against targets for acute and SNF admissions, Part A and B skilled services
- Assists with stretch assignments as needed
- Support human resource management of the Senior Clinicians and NP’s, including functions such as hiring, terminations, and performance evaluations.
- Support staff development emphasizing teamwork and a culture of accountability by mentoring staff and providing frequent and constructive feedback.
- Mentor staff towards career growth/succession planning efforts with special emphasis on retaining and recruiting a diverse work force
REQUIRED EXPERIENCE
- Minimum of 5 years clinical care & management experience
- Skilled Nursing Facility/Long Term Care experience
- Case management experience
- Knowledge CMS regulations and core aspects of an ISNP program.
- Experience in development of clinical operations, quality management, and performance management.
- Proficient at creating operational efficiencies and project management.
- Proficient in basic computer skills, virtual meeting platforms, Microsoft and LTC clinical EMRs.
- Clear, concise, and persuasive verbal and written communication.
- Adept at interacting with members and their families, other clinicians, senior leadership, and all levels of medical and non-medical professionals.
- Solid teaching skills
- Good interpersonal & organizational skills with attention to detail
- Strong commitment to excellent customer service
- Positive and enthusiastic attitude.
- Must be highly motivated, organized, flexible and adaptable to working in a fast-paced, dynamic environment.
- Must hold self to a high level of autonomy and accountability.
REQUIRED LICENSURE, CERTIFICATION, CREDENTIALING & OTHER
- Current certification as an Adult, Geriatric or Family Nurse Practitioner in the state of practice.
- Current unrestricted RN license for the state in of practice.
- Holds or is eligible for DEA licensure and CDS licensure (if required in the state of practice)
- Meets PPCM credentialing requirements.
- Holds current Basic Life Support certification.
- Holds valid driver’s license and car insurance and has reliable transportation
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