Manager, Clinical Quality Operations

Complexcare Solutions, Inc.; Northern (KY); Hybrid; USD 90,000 - 100,000; Full time

Benefits offered by this job

Remote work

Competitive compensation

Job summary

ComplexCare Solutions, Inc. seeks a Manager, Clinical Quality Operations to oversee a large field-based network of mid-level practitioners and ensure high-quality care across programs.

The role emphasizes coaching, audits, dashboards, and continuous improvement while maintaining HIPAA compliance in a fully remote environment, with minimal travel. Ideal candidates have 5+ years of management experience, a Bachelor’s degree, a current clinical license (RN preferred), and strong communication and

Qualifications

• Minimum of 5 years of management experience.
• Strong written and oral communication skills.
• Ability to organize time and work without daily supervision.
• Travel for this position will include less than 5% locally.
• Bachelor’s Degree and clinical license required.

Responsibilities

• Manage large network of field-based mid-level practitioners.
• Partner with department leaders in strategic planning and review dashboards/reports.
• Conduct 1:1 coaching with providers twice a month.
• Review audits of medical records and monitoring reports.
• Ensure compliance with HIPAA and CCS policies.

Skills

Management experience

Communication skills

Teamwork

Organizational skills

Time management

Independent judgment

Travel flexibility

Education

Bachelor’s Degree

Current clinical license

RN license preferred

Tools

Outlook

Excel

Microsoft Office

Job description

• Pay or shift range: $90,000 USD to $100,000 USD
  The actual base pay offered may vary depending on multiple factors including, but not limited to, job-related knowledge/skills, experience, business needs, geographical location, and internal equity. At ComplexCare Solutions, it is not typical for an individual to be hired at or near the top end of the range for their role, and compensation decisions are dependent upon the facts and circumstances of each position and candidate.

Description

Manager, Clinical Quality Operations

This position is remote

We are more than just a healthcare company; we are a community of professionals driven by the knowledge that our success leads to a positive impact on the communities that we support.

At ComplexCare Solutions, you’ll play a crucial part in innovating solutions that empower health plan members and healthcare providers alike. Our collaborative environment fosters creativity and initiative, ensuring that every idea and effort contributes to meaningful change in the industry. Join us and become a part of a team that turns vision into action, making a tangible impact on the future of healthcare.

Overview: The Manager, Clinical Quality Operations will be responsible for field oversight of our in-home assessment Nurse Practitioner and Physician Assistants. The focus of this role is on the day-to-day delivery of excellence in the quality of care, ensuring all clinical and operational policies and procedures are followed, and production targets are met.

Duties and Responsibilities:

• Manage large network of field-based mid-level practitioners;
• Partner with department leaders in strategic planning and review of dashboards and reporting to drive operational excellence;
• Conduct 1:1 check ins with your providers at least twice a month to include a review of their current performance and any necessary coaching;
• Review the results of audits of medical records performed by the Clinical Auditor;
• Review clinical monitoring reports for trends or individual issues;
• Develop/Review the clinical resource scorecard that summarizes the results of audits, clinical monitoring and operational monitoring reports for trends and individual issues;
• Provide specific one-on-one coaching on quality issues identified in review of the clinical resource’s audit results;
• Identify clinical resources requiring referral to a remediation training course;
• Identify clinical resources whose performance warrants referrals for a Quality Improvement Program;
• Assume role of clinical resource when questions arise in the field;
• Prepares documentation tracking coaching efforts and results of coaching efforts;
• In conjunction with the clinical training team, identify training needs, contributes to training material development, and support its implementation;
• Participate in key organizational meetings providing details specific to audit activity and outcomes;
• Maintain compliance with CCS’s policies, procedures and mission statement;
• Adhere to all confidentiality and HIPAA requirements as outlined within CCS’s Operating Policies and Procedures in all ways and at all times with respect to any aspect of the data handled or services rendered in the undertaking of the position; and
• Fulfill those responsibilities and/or duties that may be reasonably provided by CCS for the purpose of achieving operational and financial success of the Employer.

Job Requirements:

• Minimum of 5 years of management experience desired with an interest in Healthcare Field and Career;
• Goal oriented, results focused and self-motivated;
• A self-starter; ability to work in a Team Environment;
• Ability to create a positive and motivating work environment;
• Excellent written and oral communication skills;
• Ability to organize his/her time and work without direct and daily supervision;
• Strong interpersonal and organizational skills;
• Ability to work in a fast-paced environment and prioritize tasks to meet deadlines and goals.
• Knowledge of Microsoft Office Products, particularly Outlook and Excel; and
• Ability to exercise independent judgment within policy and procedure guidelines established by the company.
• Travel for this position will include less than 5% locally usually for training purposes.

Education:

• Bachelor’s Degree;
• Must have current clinical license; RN preferred

Compensation: $90,000 - $100,000

ComplexCare Solutions offers an attractive compensation and benefits package designed to support our employees.

The Company is proud to be an equal opportunity workplace and is an affirmative action employer. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, veteran status, or any other protected characteristic under federal, state, or other applicable laws.

This company utilizes E-Verify.

Preferred

Must have current license and credentials as RN or LPN

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.