Nurse Practitioner Manager

Job Summary

The Clinical Program Manager is responsible for supporting cost-effective, high-quality health care for patients enrolled in long-term care facilities within a designated region by managing the activities performed by a team of Providers and to support national clinical strategy and leadership. This position is responsible for conducting clinical audits of the providers to ensure excellent delivery of service and verifying that care is administered in accordance with all compliance programs, Medicare, Medicare Advantage, state laws and regulatory compliance, privacy and security.

Essential Job Duties

To perform this job, an individual must perform each essential function satisfactorily, with or without a reasonable accommodation.

Work closely with the leadership at the long-term care facilities in their region and company leadership to meet the key performance metrics for a market

Directly manage a team of Providers and RN Case Managers who provide care within nursing facilities

Ensure all patient services are delivered timely, effectively and within the scope of the plan

Collaborate with colleagues to explore innovative delivery models or enhancements to current delivery models and care

practices

Identify opportunities for process improvements and staff education to produce optimal outcomes

Serve as a subject matter expert (SME) on the institutional special needs plans (I-SNP) and care model

Collaborate on the development of training materials to support clinical training

Participate in clinical training initiatives

Collaborate with business leaders to implement new markets and programs

Review daily, weekly and monthly management reports to monitor and manage care delivery

Collaborate with vendors and community organizations for improved service delivery

Oversee the review and resolution of complaints and grievances

Participate in company-wide initiatives to ensure consistency and high-quality in the clinical delivery of care

Participate in company-wide quality improvement initiatives across all aspects of the organization

Ensure care is provided in compliance with all state laws and regulations

Detect, prevent and correct fraud, waste and abuse

Other duties as assigned

Job Requirements

Ability to work designated schedule, reliable attendance

Skilled business background

Proficient leadership skills

Knowledge of HEDIS and STAR ratings

Knowledge of Medicare, Medicaid, I-SNP, Nursing Facility and Managed Care

Proficient knowledge of Microsoft Office applications

Education

REQUIRED QUALIFICATIONS :

Master’s degree in nursing

Experience

3 to 5 years’ experience in long-term care or with chronically ill patients3-5 years of practice experience

1-3 years management experience in long-term care, home health or chronic condition management preferred

Vast experience in leadership and business preferred

Extensive knowledge and experience with Medicare, Medicaid, I-SNP, Nursing Facility and Managed Care preferred

HEDIS / STARs experience preferred

License / Certification(s)

APRN or PA license required

Supervisory Responsibilites

First line supervision and delegation of duties to all Providers (NPs / PAs) and RN Case Managers in direct clinical care services

Frontline oversight, planning, and delegation of onboarding activities of new employees within the designated region

Responsible for provider relations issues below regional or corporate levels that would affect P&Ps

Supervise support staff including scheduling and assigning work, reviewing performance, recommending salary increases, promotions or discharges

Occasionally needs manager’s direction due to extraordinary circumstances

EQUAL OPPORTUNITY EMPLOYER

This Organization is an equal opportunity employer. We do not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. This Organization will make reasonable accommodations for qualified individuals with disabilities should a request for an

accommodation be made. A key part of this policy is to provide equal employment opportunity regarding all terms and conditions of employment and in all aspects of a person's relationship with the Organization including recruitment, hiring, promotions, upgrading positions, conditions of employment, compensation, training, benefits, transfers, discipline, and termination of employment.