Regional RN: Provider Engagement & Clinical Ops

Healthmap Solutions; Miami (FL); Hybrid; USD 90,000 - 130,000; Full time

Job summary

Healthmap Solutions is seeking a Regional Manager of Clinical Services in Florida to plan, direct, and oversee a team delivering provider and member facing services. You will drive engagement, clinical operations, and quality initiatives across the region, ensuring adherence to NCQA-like standards and HIPAA regulations.

In this role you will coach staff, monitor KPIs, collaborate across disciplines, and report on performance, while traveling regionally up to 25% to support practice visits and

Qualifications

• Bachelor's degree in healthcare or related field required.
• Active, unrestricted RN license required.
• Minimum of 3 years progressive supervisory and/or management experience required.
• 5 years of progressive experience in healthcare services, clinical operations, quality, or care management required.
• 5 years of experience in closure of care gaps or care coordination preferred.
• Prior experience building and managing relationships with health care providers or patients preferred.
• Proof of valid and unrestricted driver's license required.
• Must be able to successfully comply with the credentialing process.

Responsibilities

• Function as ambassador for organization with all internal and external customers
• Collaborate as needed with team to help engage providers and members and serve as escalation point for difficult practices and/or members
• Implement organization policies, procedures, workflows, and action plans to drive team performance
• Ensure collaboration and communication among multi-disciplinary teams to ensure they are coordinated in working toward maximum customer engagement and improved member outcomes
• Monitor KPIs to identify trends and areas of opportunity that will guide regional strategy; Develop action plans and/or remediation strategies to address areas of opportunity
• Develop, monitor, and report on team performance and productivity
• Troubleshoot technical issues as needed
• Promote an environment of continuous improvement through on-going team audits, provider practice visits, and monitoring of member calls to identify gaps in teams' skills and competencies; Work to develop ongoing team education to address areas of opportunity
• Develop, coach, and mentor team members to achieve company, department, and individual goals
• Conduct yearly performance evaluations and provide constructive feedback to redirect team members with a positive discipline approach
• Maintain team performance according to NCQA standards including but not limited to appropriate provider and member documentation
• Comply with HIPAA privacy laws, all other federal and local regulations, and company security policies
• Provide recommendations to the leadership regarding necessary operational adjustments needed to ensure organizational objectives and goals are met
• Perform other related duties as assigned

Skills

Leadership

Communication

Team management

Problem solving

Customer engagement

Analytical skills

Education

Bachelor's degree in healthcare or related field

Master's degree preferred

Tools

Microsoft Office

Job description

Healthmap Solutions is seeking a Regional Manager of Clinical Services in Florida to plan, direct, and oversee a team delivering provider and member facing services. You will drive engagement, clinical operations, and quality initiatives across the region, ensuring adherence to NCQA-like standards and HIPAA regulations.

In this role you will coach staff, monitor KPIs, collaborate across disciplines, and report on performance, while traveling regionally up to 25% to support practice visits and