The Clinical Practice Director will support the Clinical Practice Lead in creating a healthcare Center of Excellence in alignment with the industry. The Clinical Practice Director will support all practice objectives, have responsibility for all delivery parameters and will be responsible for growing the overall practice revenues.
Primary responsibilities include:
Support all clinical service delivery done offshore in the Utilization management, care management and cost containment areas for healthcare and workers' compensation products. The support will be in the following areas:
- Directly responsible for P&L of the onshore BPO clinical processes for which the role will have a dotted line reporting into the operations manager and direct reporting into the clinical practice lead.
- Support all new clinical process transition with re to hiring, training, and in meeting all Service levels including but not limited to TAT, quality and productivity expectations as per the contractual agreement
- Solution for new capabilities
- Standardize reporting that will enhance insights into internal operations as well as on clientsâ€™ overall portfolio.
- Work closely with vendors in clinical talent management and helping with a steady sourcing mechanism that is both cost and talent effective.
- Works closely with Operations, Workforce Management, Business Excellence and Training functions in building standard practices for all delivery parameters across delivery geographies, in alignment with industry leaders and market requirements.
- Participate in business reviews with clients for all onshore clinical processes and as needed for offshore accounts.
- Proactively engage with business transformation teams and operations teams to identify innovative solutions that can help either improve experience or reduce cost per review in all utilization management related functions including prospective, retrospective, concurrent reviews and appeals reviews.
- Keep track of market movement and the key gaps in capabilities, thereby supporting achievement of revenue targets from newer capabilities in the clinical practice, year over year.
- Help elevate the HGS clinical practice brand in the market as evidenced by more RFPs relevant to the newer capabilities that being developed.
- Bachelorâ€™s degree in nursing, health care administration or health services. MBA preferred.
- Unrestricted nursing license to practice within the United states is mandatory. Compact nursing license or license in Illinois, Michigan and/or Pennsylvania preferred.
- 5 or more years' experience in a health plan or large health system is preferred.
- Minimum of 3 years' experience leading and managing teams, including hiring, training, assigning work and managing performance.
- A background that includes strong clinical work, experience in managed care and managing a call center team in the medical management functions with ability to understand, interpret and apply complex federal and state health care compliance laws, rules, regulations, and organization and industry-based policies, procedures, and guidelines.
- Experience in acute hospital case management, discharge planning, complex case management or utilization management preferred.
- Working knowledge of NCQA and health plan requirements related to utilization management.
- Excellent computer skills including utilization management and/or case management software required. Proficiency in Microsoft Word, PowerPoint, Excel.
- Previous experience in analysis of utilization and quality management data required.
- Able to resolve conflicts and/or negotiate with others to achieve positive results. Demonstrates resourcefulness, diplomacy, organizational and analytic skills.
- Highly organized, self-directed and able to work independently under general direction with minimal supervision.
- Ability to assume responsibility, take initiative, follow up on assignments, make appropriate decisions within the scope of the position, handle multiple projects simultaneously in a high-volume work environment and assume accountability for own decisions and aware of when to escalate issues to the Clinical Practice Lead.
- Must thrive in a rapidly changing environment and understand when to keep Clinical Practice Lead informed of any delays which could disrupt delivery of health care services or internal operations.
- Able to work effectively and collaboratively with inter-disciplinary teams across global delivery centers.
- Ability to develop and implement educational materials and presentations for all levels of learners.
- Ability to maintain member information in a confidential manner and ensure HIPAA compliance at all times.
- Superior verbal and written communication skills.
- Ability to effectively present information and respond to questions among a variety of audiences, including internal and external stakeholders.
- Ability to travel as needed.