RN Regional Manager, Clinical Services (Must reside in Florida)

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

Job summary

Healthmap Solutions is seeking a Regional Manager Clinical Services in Florida to lead provider and member engagement initiatives. You will oversee the administrative, clinical, and quality activities to improve health outcomes for patients with complex conditions.

The role emphasizes provider-facing leadership, KPI monitoring, and cross-functional collaboration while ensuring HIPAA and NCQA compliance. Travel within Florida is required as needed.

Qualifications

• Bachelor’s degree in healthcare or related field.
• Active, unrestricted RN license.
• Minimum of 3 years supervisory/management experience.
• 5 years of experience in healthcare services, clinical operations, or care management.
• Experience building relationships with providers or patients preferred.

Responsibilities

• Function as ambassador for the organization with internal and external customers.
• Collaborate with teams to 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 among multi-disciplinary teams to maximize customer engagement and improve member outcomes.
• Monitor KPIs to identify trends and develop regional strategy with remediation plans.
• Develop, monitor, and report on team performance and productivity.
• Troubleshoot technical issues as needed.
• Promote continuous improvement through audits, provider visits, and training.
• Develop, coach, and mentor team members to achieve goals.
• Conduct yearly performance evaluations and provide constructive feedback.
• Maintain NCQA standards including proper documentation and compliance with HIPAA.
• Provide recommendations to leadership on operational adjustments.
• Perform other related duties as assigned.

Skills

Leadership

Communication skills

Multitasking

Critical thinking

Employee engagement

Microsoft Office

Education

Bachelor's degree in healthcare or related field

Master’s degree preferred

Job description

Company Background

Healthmap Solutions is the future of specialty health management that focuses on progressive diseases, with a particular expertise in kidney health populations. Healthmap Solutions uses clinical big data resources and high-powered analytics to power complex specialty health management programs. Healthmap Solutions is a diverse, growing company committed to our clients and our employees. We are champions for better health, for those who need us most.

Description

Position at Healthmap Solutions

Company Background

Healthmap Solutions is the future of specialty health management that focuses on progressive diseases, with a particular expertise in kidney health populations. Healthmap Solutions uses clinical big data resources and high-powered analytics to power complex specialty health management programs. Healthmap Solutions is a diverse, growing company committed to our clients and our employees. We are champions for better health, for those who need us most.

Position Summary

The Regional Manager Clinical Services will be responsible for planning, directing, and overseeing the performance of a team of assigned Provider and Member facing staff. The position will oversee the administrative, clinical, and quality activities related to building strong provider and member engagement and health outcomes.

In this role, we're looking for candidates that are heavy on the Provider facing side.

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 Key Performance Indicators (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 National Committee for Quality Assurance (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

Requirements

• Bachelor's degree in healthcare or related field required; master’s degree preferred
• 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

Skills

• Excellent verbal, written and presentation skills
• People skills to develop and maintain strong internal and external relationships
• Ability to multitask, prioritize, and create solutions in a challenging environment
• Demonstrated leadership skills and ability to create and maintain a positive work environment
• Strong critical thinking and analytical skills
• Ability to foster strong employee engagement among the team
• Must be proficient in Microsoft Office: Outlook, Word, Excel, PowerPoint

Travel

Moderate Travel, up to 25%, throughout the state of Florida.

Americans with Disability Specifications

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

As an Equal Opportunity Employer, we will not discriminate against any job candidate or employee due to age, race, religion, ethnicity, national origin, gender, gender identity/expression, sexual orientation, disability, familial status, veteran status, marital status, parental status, or pregnancy. In our innovative and inclusive workplace, we prohibit discrimination and harassment of any kind.