Clinical Manager - Clinically Integrated Network - PGH Region - FT

Highmark Health; Jefferson Hills (Allegheny County); On-site; USD 80,000 - 100,000; Full time

Job summary

Highmark Health is seeking a Clinical Manager for its Clinically Integrated Network in the PGH region. The role involves leading care navigators, improving population health, and ensuring compliance with regulations. Ideal candidates will possess a Registered Nurse License and relevant experience, focusing on enhancing patient care and satisfaction.

Qualifications

• Bachelor's degree or relevant experience required.
• Registered Nurse License required.
• Knowledge of medical terminology and coding.

Responsibilities

• Build and lead a team of care navigators and health coaches.
• Develop workflows and protocols for care navigation.
• Monitor key performance indicators for program effectiveness.

Skills

Knowledge of medical terminology

Insurance theory

ICD-9 coding

CPT coding

Education

Bachelor’s degree or relevant experience

Registered Nurse License

Bachelor of Science in Nursing

Job description

Clinical Manager - Clinically Integrated Network - PGH Region - FT

The Clinical Manager will play a pivotal role in building and leading a high-performing team of care navigators and health coaches dedicated to supporting AHN and independent primary care practices participating in AHN's Clinically Integrated Network. This is an exciting opportunity to establish a new clinical support model focused on improving population health, enhancing patient experience, and driving positive health outcomes for Medicare beneficiaries.

Key Responsibilities Include:

• Build, train, and supervise a team of care navigators and health coaches.
• Collaborate with CIN leaders and independent primary care practices to implement and optimize the clinical support model.
• Develop and implement workflows and protocols to ensure effective care navigation and health coaching services.
• Monitor and analyze key performance indicators (KPIs) to track program effectiveness and identify areas for improvement.
• Ensure compliance with all relevant regulations and guidelines.
• Travel regularly to primary care practices within the region to provide on-site support and training.

GENERAL OVERVIEW:

Manages the daily operations related to clinical activities for designated sites.

ESSENTIAL RESPONSIBILITIES:

• Responsible for the clinical professional services for designated sites.
• Manage the day-to-day operations and office functions.
• Supervises staff, resolves problems and implements approved disciplinary action.
• Interviews, hires, trains and conducts performance evaluations.
• Manages and monitors key financial and revenue cycle metrics including staff hours, resource allocation, expense budget, patient volumes and the revenue cycle process.
• Provides primary (or secondary) review of reconciliation of monies being collected and deposited.
• Responsible for monitoring patient satisfaction reports, identifying variances from standard, addressing and resolving patient complaints.
• Responsible for quality and performance improvement by monitoring metrics and addressing deficiencies.
• Implements and coordinates practice performance improvement programs.
• Perform clinical duties necessary to support site.
• Works collaboratively with physicians, leadership and health professionals to accomplish organization and practice goals.
• Ensures compliance with all regulatory requirements.
• Participates in budget preparation for clinical and operational activities.
• Establishes policies and procedures related to patient care.

QUALIFICATIONS

Minimum

• Bachelor’s degree or relevant experience and/or education as determined by the company in lieu of bachelor's degree.
• Registered Nurse License required.
• Bachelors of Science in Nursing required if working in an Oncology setting.
• Knowledge of medical terminology, insurance theory and ICD-9, and CPT coding required.
• CPR – American Heart Association
• Act 34 Criminal Background Clearance Certificate
• Act 33 Child Abuse Clearance Certificate
• Act 73 FBI Fingerprinting Criminal Background Clearance Certificate

Preferred

• Master’s degree in nursing or related health care field preferred.
• Professional certification in area of nursing expertise preferred.
• 1-3 years supervisory experience preferred.

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.

Talentify 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, or protected veteran status.

Talentify provides reasonable accommodations to qualified applicants with disabilities, including disabled veterans. Request assistance at [e-mail] or 407-000-0000.

Federal law requires every new hire to complete Form I-9 and present proof of identity and U.S. work eligibility.

An Automated Employment Decision Tool (AEDT) will score your job-related skills and responses. Bias-audit & data-use details: www.talentify.io/bias-audit-report . NYC applicants may request an alternative process or accommodation at [e-mail] or 407-000-0000.