small11

 

RN, Clinical Program Manager at ConcertoHealth
Southfield, MI, US

Job Details

Description

 

ABOUT CONCERTO HEALTH

ConcertoHealth Inc. is the leading provider of specialized primary care and supporting clinical services for complex, frail, elderly, and dual-eligible patients. Operating exclusively in value-based agreements, ConcertoHealth provides high-touch, individualized care for patients, and deploys wraparound clinical resources to extend the reach of primary care practices. This comprehensive medical management solution, elevated by Concerto’s proprietary population health technology, improves overall healthcare quality and patient outcomes, benefitting payers and their provider networks.

Concerto delivers comprehensive care to Medicare, Medicaid, and complex-needs patients.  The Concerto name reflects our unique approach to healthcare. It’s about how we work in concert with patients, providers, and health plans. Our approach focuses on bringing harmony across the spectrum of a patient’s care, health, and dignity.

The company is headquartered in Aliso Viejo, Ca. For more information, please visit: www.concertohealth.com

 

JOB SUMMARY: 

The Clinical Program Manager will serve in a critical capacity supporting the Senior Vice President for Quality and Utilization Management (SVP) and the Director of Utilization Management.  He/she will be focused on operational excellence of Concerto’s Quality and Utilization Management Departments.  The Clinical Program Manager will be required to continuously assess the department education and operational needs against current process improvement activity as well as client policies, procedures and expectations keeping all process flows current and ensuring they are provided timely to Training. The Clinical Program Manager will be responsible for the review and updating of Quality and UM policies, providing needed materials for auditing, and other operational support as needed for special projects.  The Clinical Program Manager will serve as the executive officer for the SVP and for the Director of Utilization Management.

 

ESSENTIAL DUTIES AND RESPONSIBILITIES:

  • Evaluate and identify processes changes to current workflows and develop associated VISIO document and Training Aide
  • Track and monitor staff for required annual education and report gaps to Clinical Managers
  • Schedule education for staff as needed for changes in workflow processes
  • Monitor staff compliance with new workflows
  • Collaborate with Director Training new workflows
  • Document all education provided
  • Assist UM Director with special projects
  • Assist SR VP, Medical Director with Special projects
  • Manage quarterly UMQM Meeting agendas, materials etc. in meeting accreditation and regulatory requirements
  • Assist in other projects and initiatives to prioritize and execute critical initiatives and ensure resources are deployed sufficiently to ensure successful implementation.
  • Take initiative and support all SVP clinical areas with project activities.
  • Monitor key performance indicators and escalate issues promptly to SVP and UM and QI Leadership
  • Assist in requesting and evaluating appropriate reports.
  • Create Business Requirements Documents, Change Requests, and collaborate with IT on information system modifications and reporting needs.

QUALIFICATIONS:

  • RN licensure.
  • Bachelor’s Degree Preferred.
  • Minimum two years experience working in Utilization Management and/or Care Management.
  • Project management and process improvement skills required.
  • Strong analytical skills required, including a thorough understanding of how to interpret business needs and translate them into application and operational requirements.
  • Excellent verbal and written communication skills.
  • Ability to direct and execute complex data analysis to support any recommendations.
  • Deep understanding of upstream and downstream impacts of any solution implemented and ability to plan and execute to mitigate risks.
  • Self-driven/directed.
  • Ability to interact professionally with a diverse group, executives, managers, front-line staff and subject matter experts.
  • Strong ability to align objectives cross-functionally and drive change effectively.
  • Expert level proficiency with Microsoft Excel, Visio, PowerPoint, MS Project, and Word.