Job Description
Job DescriptionDescriptionAstrana Health is seeking a Manager - Clinical Operations to serve as our main gatekeeper for identifying high-risk patients who are appropriate for our various clinical programs in the RI region, based on predefined criteria. Additionally, this Manager will oversee a team of direct reports consisting of social workers, care coordinators, and community health workers.
You would be overseeing performance of the following programs: Transitions of Care, Care Management, Care at Home, Advanced Illness, SNF at Home, PT at Home, Remote Patient Monitoring and other vendor program partnerships. This position is responsible for ensuring that clinical programs adhere to established criteria, along with patient length of stay. The Manager of Operations conducts annual evaluations of each clinical program, tracks weekly KPIs to measure team productivity, patient engagement, and care management metrics, as well as submits quarterly client engagement reports and achieving a 60% overall patient engagement rate for Astrana Health RI clinical programs.
We are seeking candidates who have either a nursing or MSW background and are well-versed within the managed care space.
Our Values:
- Put Patients First
- Empower Entrepreneurial Provider and Care Teams
- Operate with Integrity & Excellence
- Be Innovative
- Work As One Team
What You'll Do
- Point for identifying high-risk patients appropriate for program engagement (payors: BCBS MA, BCBS Comm, MSSP, UHC MCD, NHP MCD, Tufts MCD) with the goal of achieving an overall 60% average patient engagement rate.
- Weekly tracking of patient engagement rate across the following clinical programs: Transitions of Care, Care Management, Care@Home, Advanced Illness, Remote Patient Monitoring, SNF@Home, PT@Home and others as assigned.
- Weekly tracking of TOC completion, Readmission rates, Admits/1000, and ED visits/1000
- Owns oversight for length of stay in programs, graduation, annual program evaluations, etc.
- Responsible for review and submission of quarterly client reports
- Conducts regular check-ins with direct reports.
- Reviews weekly metrics with direct reports and identifies areas of improvement.
- Mentors’ direct reports to meet department and company objectives.
- Attends and participates in operational or interdepartmental meetings as requested.
- Complete special projects when required.
- Implements and manages rapid cycle operational performance improvement using PDSA.
- Other duties as assigned.
Qualifications
- Social Worker (SW) or Registered Nurse (RN) with a minimum of 5 years’ experience in managed care, health plan, or IPA arenas to include Care Management, Quality Improvement, outpatient programs, care management programs, and health plan incentive programs to include P4P/HCC/STAR/HEDIS.
- Minimum of 3 years management experience with direct reports.
- Experienced with health plan guidelines/criteria/CMS/NCQA.
- LEAN/Six Sigma certification is a plus.
- Business training or degree a plus.
Environmental Job Requirements and Working Conditions
- This is a hybrid position, where you will work in the office, at home, and in the field on a weekly basis. The office is located at 1301 Atwood Avenue, Johnston RI.
- The target compensation for this position is $105K - $113K per year.
Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@networkmedicalmanagement.com to request an accommodation.
Additional Information:
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.