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Manager, Clinical in Richmond, VA at KEPRO

Date Posted: 1/24/2018

Job Snapshot

Job Description

KEPRO

JOB DESCRIPTION

JOB TITLE:                  Manager,Clinical        

DEPARTMENT:           Operations

FLSA STATUS:            Exempt

Summary Description

Serve as the leadto oversee Utilization Management (UM) functions for the project. Coordinateswith the Client on UR decisions and issues, and communicates with providers andinpatient facilities regarding utilization review decisions and other clinicalmatters. Develops and leads utilization review staff in the activities requiredto perform clinical services in order to facilitate and support quality, costeffect outcomes and minimize fragmentation of health care delivery.

Accountabilities

  • Oversee,coordinate, and monitor all Utilization Management team activities.
  • Ensureadequate staffing and contractual service levels are adhered to by implementingand monitoring clinical staff productivity and performance indicators.Maintains effective team member relations.
  • Leadsteam members in improving utilization management skills, creativity, andproblem solving.
  • Workwith management team to develop and enhance the operational structure includingskill set requirements, gap analysis, and training using workforce planning.
  • Managesand completes assigned work plan objectives and projects on a timely basis.
  • Provideadvice and assistance to leaders in the planning, implementation, andevaluation of modifications to existing operations, systems, and procedures.Collaborate with leadership in the development of new and enhanced products andservices. 
  • Representsthe clinical department by participating on committees, task forces, workgroups, and multidisciplinary teams. Maintains professional relationships withprovider community and external customers and identifies opportunities forimprovement.
  • Participatesin the development of policies and oversees clinical staff activities to ensurecompliance with regulatory and accrediting standards.
  • Providesreports of compliance and other Utilization Management activities.

The list ofaccountabilities is not intended to be all-inclusive and may be expanded toinclude other education- and experience-related duties that management may deemnecessary from time to time.

Qualifications

  • Bachelor’sdegree and active non-restricted, clear RN license required.
  • Demonstratedproficiency in MS Office applications.
  • Abilityto maintain a positive attitude and contribute both as an individual and a teammember to achieve the goals of the department.
  • Abilityto professionally respond to change and handle multiple and changing prioritieswith sometimes conflicting deadlines.

Experience

  • 5+years of clinical experience
  • Minimumof 3 years’ experience in UM/UR and Appeals required.
  • Experiencewith State Medicaid programs, strongly preferred.
  • Minimum3 years staff/workload management experience required.
  • Experiencewith a start-up, strongly preferred.
  • Experiencein services such as DME, Dental, Medical/Surgical, Psych, BH, Home Health etc.,strongly preferred.

Mental and Physical Requirements 

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

EOE AA M/F/Vet/Disability

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