Clinical, Director (RN, LCSW or LPC)

Acentra Health; United States; On-site; USD 117,000 - 146,000; Full time

Job summary

Acentra Health is seeking a Clinical Director to lead and oversee clinical program activities, emphasizing consistency, accuracy, and efficiency. You will guide programs toward enhanced clinical performance while ensuring contract deliverables meet high standards.

Responsibilities include directing utilization and case management across multiple specialties, monitoring indicators, and driving process improvements. Strong SME capabilities and HIPAA compliance are essential.

Qualifications

• Active, unrestricted RN license or compact state license; LCSW or LPC eligible.
• Bachelor's degree or equivalent experience in nursing, healthcare administration, or related field.
• Extensive experience managing clinical care management (UM) operations.
• 3 years of utilization review experience; 2 years of clinical management.

Responsibilities

• Lead and oversee clinical program activities to ensure consistency and accuracy.
• Oversee utilization management and case management across services.
• Provide guidance to direct reports in their roles, overseeing UM review and case management.
• Ensure operations comply with contractual requirements and monitor critical indicators.
• Identify opportunities to improve operating efficiencies.
• Serve as a Subject Matter Expert (SME).
• Contribute to organizational priorities and operational indicators.
• Foster effective communication with staff and across departments.
• Oversee contract activities including SLA metrics and staff development.
• Manage the clinical quality program, including auditing and QIPs.
• Perform other duties as assigned and adhere to HIPAA and Privacy Rules.

Skills

Clinical program leadership

Utilization review (UR)

Case management

Communication skills

Team leadership

InterQual/Milliman criteria

URAC standards

Microsoft Office

Healthcare industry knowledge

Education

Bachelor's degree or equivalent experience in nursing, healthcare administration, or related area

Active RN license

LCSW or LPC license

Tools

Microsoft Office

UM system experience

Contract management software

Job description

Company Overview

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

Job Summary And Responsibilities

Job Summary

The Clinical, Director directs and oversees all clinical program activities, emphasizing the need for overall consistency, thoroughness, and accuracy. The primary purpose is to guide the program towards enhanced clinical efficiencies, ensuring that deliverables and assigned contract functions consistently meet the highest standards.

Responsibilities

• Conduct UM reviews across various specialties such as Advanced Imaging, Audiology, Chiropractic, Dental, DME, Home Health, Hospice, Inpatient, Mental Health (including Psychiatry), MRO, Occupational Therapy, Optometry, Outpatient, Pharmacy, Physical Therapy, Physician, Podiatry, Rehabilitation, Speech Therapy, Transplant, and Transportation.
• Manage Care Coordination services for a specific member population.
• Provide guidance to direct reports in their roles, overseeing utilization management review and case management.
• Ensure clinical operations comply with contractual requirements by monitoring critical indicators and adjusting processes to address negative variances.
• Identify opportunities for enhancing operating efficiencies.
• Serve as a Subject Matter Expert (SME).
• Contribute to achieving annual organizational priorities and operational indicators.
• Foster effective communication with staff through various channels, such as one-on-one meetings, team meetings, and interdepartmental meetings.
• Oversee contract activities, including service level agreement metrics, processes, staff development, internal training, review process quality, case management effectiveness, deliverables, and budgetary compliance.
• Manage the clinical quality program, encompassing auditing, Quality Improvement Plans (QIPs), and administration of the Local Quality Improvement Committee.
• Perform other duties as assigned.
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.

Qualifications

Required Qualifications

• Active, unrestricted Licensed RN or compact state, an active unrestrictive Licensed Clinical Social Worker (LCSW) or LPC.
• Bachelor's Degree or equivalent directly applicable experience in nursing, healthcare administration, or related area is preferred.
• Extensive experience managing clinical care management (UM) operations.
• 3 years of utilization review experience.
• 2 years of clinical management experience required.

Preferred Qualifications

• Strong verbal and written communication skills are essential.
• Current working knowledge of utilization management, case management, and managed care.
• Customer-focused, results-oriented, with the ability to build and maintain relationships with both internal and external customers.
• Organizational skills and the ability to plan and prioritize multiple assignments are essential.
• Current knowledge of InterQual and Milliman criteria.
• Proficient in examining and re-examining operations and procedures, formulating policy, and developing and implementing new strategies and procedures.
• Familiarity with the U.S. healthcare industry.
• Experience using systems that support Utilization and Case Management processing.
• Demonstrated expertise in managing diverse customer needs.
• Understanding of URAC standards and processes.
• Ability to participate as a team member, fostering collaborative decision-making among leadership, committees, teams, or workgroups of diverse composition.
• Proficiency in Microsoft Office applications and other essential software programs for job functions.
• Ability to develop, plan, and implement short- and long-range goals.
• Skill in employee development and performance management.
• Capability to provide technical guidance and leadership to the management team.
• Advanced verbal and written communication skills, with the ability to work effectively with a wide range of constituencies in a diverse community.

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

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.

Experience in Lieu of Degree

For non-clinical roles, or when not required by the contract specifically, the Company acknowledges that practical, hands-on experience can provide skills and competencies equivalent to formal education. As such, in cases where a Bachelor's degree may be required, the Company will accept a minimum of six (6) years of directly relevant professional experience in lieu of a degree. In instances where the candidate has an Associate's degree, the Company will accept a minimum of three (3) years of directly relevant professional experience in lieu of the Bachelor's degree.

Compensation

The pay range for this position is listed below.

$117,120 - $146,400

Based on our compensation philosophy, an applicant's position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level.

EEO 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, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.

Pay Range

USD $117,120.00 - USD $146,400.00 /Yr.