Clinical Operations, Manager

Acentra Health, LLC; United States; Remote; USD 94,000 - 105,000; Full time

Benefits offered by this job

comprehensive health plans

paid time off

retirement savings

corporate wellness

educational assistance

corporate discounts

more

Job summary

Acentra Health is seeking a Clinical Operations Manager - RN to supervise the case review teams and ensure quality and regulatory contract deliverables. The role emphasizes mentoring, coaching, and supporting an interdisciplinary team to meet payer/client requirements.

The position is remote with standard hours 9:00 AM–5:30 PM EST, Monday to Friday, with possible after-hours work. Strong leadership and regulatory knowledge are essential for success.

Qualifications

• Active, unrestricted RN licensure.
• Pursuing ongoing education and self-development to stay current with case review standards.
• 4+ years of clinical experience in a medical setting.
• Quality management experience with projects or reporting outcomes.
• Case review experience with evidence-based practice standards.
• Knowledge of the No Surprises Act and Dispute Resolution.

Responsibilities

• Supervise, mentor, coach, and develop the case review team in the clinical area of case review and dispute resolution.
• Oversee workload, assess, evaluate, and address assignments; adjust to contract requirements.
• Develop staff, identify orientation and learning needs, and implement plans.
• Quality monitoring; ensure compliance with regulatory and contractual standards.
• Develop and revise case review tools to support programs.
• Maintain open communication and timely documentation and reporting.
• Maintain client confidentiality and comply with HIPAA policies.
• Participate in contract management activities and deliverables.
• Perform other duties related to case review supervision.
• Read, understand, and adhere to corporate policies including HIPAA.

Skills

Mentoring

Coaching

Communication skills

Problem solving

Conflict resolution

Team leadership

Education

Bachelor's degree in nursing or related field

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

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  Acentra seeks a Clinical Operations, Manager - RN to join our growing team.

  
  

  Job Summary:

  
  

  The supervision and day-to-day activities of the assigned Case Review Teams. Mentoring, coaching, and training team members in the case review process to ensure quality and contract deliverables are met. Using independent judgment, utilizing clinical knowledge and competence, communication skills, problem-solving and conflict resolution to effectively ensure optimal client outcomes with consideration of payer/client requirements. Working effectively with all healthcare team members internally and externally. Supporting the interdisciplinary team with the underlying objective of ensuring contractual, regulatory, and accreditation compliance, and providing timely and accurate data and communications.

  
  

  ***Position is remote***

  
  

  ** Required Work Hours: Monday - Friday from 9:00 AM - 5:30 PM EST. **

  
  

  ** Occasionally, work may be required in the evenings, holidays and on weekends. **

  
  

  Job Responsibilities:

  
  
  
  
  • Supervise, mentor, coach, and develop the case review team in the clinical area of case review and dispute resolution, ensure a high level of clinical knowledge and performance by the clinical team. Fosters a caring philosophy in leadership and all aspects of the case review process.
  
  
  • Oversee teamwork assignments, assess, evaluate, and address workload; adjust to meet the demands of the department and contract requirements; measure results and initiate personnel actions as required. Applies a comprehensive knowledge of case review and caring concepts to all aspects of assignments.
  
  
  • Develop case review staff, identify orientation and continuous learning needs in collaboration with direct leadership, and develop and implement plans to address those learning needs.
  
  
  • Responsible for quality monitoring activities, including identifying areas of improvement for individual team members, processes, and quality improvement initiatives. Ensures compliance with regulatory and accreditation standards and contractual service level agreements.
  
  
  • Participates in developing, implementing, evaluating, and revising, case review tools that specifically support case review programs.
  
  
  • Maintains open communication with all appropriate parties and facilitates communication to/between members of the care team; ensures accurate and timely documentation and reporting.
  
  
  • Maintains strict standards for client confidentially and client-related information; complies with all organizational, state, and federal regulations and policies on confidentially.
  
  
  • Participates as a leadership team in all contract management activities as well as contract administration deliverables.
  
  
  • Performs other duties as related to case review supervision functions as needed.
  
  
  • Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.
  
  
  
  

Qualifications

Required Qualifications/Experience:

• Active, unrestricted RN licensure.


• Requires pursuing ongoing education, certification, and self-development to remain current with case review standards.


• 4+ years of clinical experience in a medical setting.


• Quality management experience with projects, reporting outcomes, or other QIP involvement.


• Case review experience with evidence-based practice standards.


• Knowledge of the No Surprises Act and Dispute Resolution.

Preferred Qualifications/Experience:

• Bachelor’s degree in nursing or related nursing field.


• Previous workload management experience.


• Previous client management experience.


• Strong supervisory experience and knowledge; Independent Dispute Resolution recommended.


• Strong team-building skills.


• Excellent verbal and written communication skills; excellent interpersonal communication and negotiation skills.


• Ability to utilize critical thinking and apply sound judgment for decision-making and guiding staff.


• Understanding of the importance of instilling a caring philosophy in all aspects of the case review process.


• Analytical, reporting, and data management skills.


• Strong organizational and time management skills and the capacity to prioritize multiple tasks.


• Demonstrates the ability to be organized and efficient in prioritizing and managing assignments with minimal oversight and direction.


• Computer proficiency in Microsoft Office and other software programs and the ability to enter and retrieve data from relevant computer systems.

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

• comprehensive health plans


• paid time off


• retirement savings


• corporate wellness


• educational assistance


• corporate discounts


• more

Thank You!

We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search!

~ The Acentra Health Talent Acquisition Team

Visit us at https://careers.acentra.com/jobs

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.

Compensation

The pay for this position is listed below.

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.

Pay Range

USD $93,520.00 - USD $105,000.00 /Yr.