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The Role
Oversee regional provider- and member-facing clinical services teams, including performance, quality, care coordination, provider engagement, compliance, and member outcomes. Monitor KPIs, develop remediation plans, conduct audits and practice visits, coach staff, and ensure adherence to NCQA, HIPAA, and organizational standards. The role also manages team evaluations, operational improvements, escalations, and cross-functional collaboration across Florida.
Summary Generated by Built In
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.
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.
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
Limited Travel, Scheduled per needs of the business.
#LI-Hybrid
Limited Travel, Scheduled per needs of the business.
#LI-Hybrid
Skills Required
- Bachelor's degree in healthcare or a related field
- Active, unrestricted RN license
- At least 3 years of progressive supervisory or management experience
- At least 5 years of progressive experience in healthcare services, clinical operations, quality, or care management
- At least 5 years of experience closing care gaps or coordinating care
- Experience building and managing relationships with healthcare providers or patients
- Valid and unrestricted driver's license
- Successful completion of the credentialing process
- Proficiency in Microsoft Office, including Outlook, Word, Excel, and PowerPoint
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The Company
What We Do
Healthmap Solutions (Healthmap) is a NCQA-accredited industry leading kidney population health management company. Healthmap uses big data resources, integrated advanced technology, clinical expertise, and complex care management to improve the lives of people living with kidney disease. Healthmap also helps healthcare providers and payers achieve the value-based results they need. Our company is a diverse and growing organization committed to our clients, the patients we support, and our employees. We are champions for better health, for those who need us most.
