Manager of Clinical Services (Central US)

Job Title: Manager of Clinical Services             

Exempt Status: Exempt

Division: Clinical Services                    

Reports to: Director of Clinical Services

Location: Remote, CST Time Zone

Episource, with over 3000 employees worldwide, is a leading provider of risk adjustment services and solutions for health plans.  Our services help Medicare Advantage, Commercial/Exchange, and Medicaid managed care plans improve and support accurate reimbursement in a post-Affordable Care Act market. Our services include retrospective chart reviews, medical record retrieval, HEDIS/ACO quality reporting, and data analytics, allowing payers and providers to dramatically reduce costs and improve quality of care.

Job Summary:

The Manager of Clinical Services is a regional position to assist the Director of Clinical Services with overall management of the Episource provider network with the goal of improving provider performance across their region.   The Manager is responsible for every aspect of day-to-day management of all providers in their region with the assistance of any regional Supervisors.  The Manager of Clinical Services is responsible for the direct oversight and management of any regional Supervisors.

Responsibilities:

  • Provide day-to-day management of all providers in the region by engaging providers in that reporting relationship.
  • In the absence of a local/regional supervisor
    • Serve as the first-line of contact for all providers in the Central US for day-to-day questions and concerns.
    • Work in collaboration with the Provider Trainer to facilitate on-boarding training sessions with new providers in region – participate in person when logistically possible
    • Provide mentorship and coaching to providers in the Central US
    • Schedule and conduct weekly team meeting via remote /webinar / telephonic meeting
    • Schedule & facilitate in-person quarterly provider team meetings
    • Function as a liaison between the client, Episource management and the Episource provider team
    • Meet with project management team as needed
    • Attend weekly Episource / client project calls
    • Meet with the client’s participating providers (PCP’s) in the field as needed – to provide education regarding the Episource health risk assessment project
    • Work with the Episource and project management teams on the implementation of events and activities as needed
  • Additional responsibilities include: attendance at all client meetings in their region, communicating client specific needs to the provider team, attendance at all scheduling and operational meetings and communicating operational updates to their team of providers.  Monitoring all provider KPI’s, in cooperation with the Provider Trainer, ensure that remote and/or in-person on-going educational and coaching sessions are completed based on those KPI results.
  • Monitor performance of providers in region by reviewing the provider KPIs, monitoring weekly KPI reports and provide monthly KPI reports to the Director of Clinical Services.
  • Based on KPI reports work collaboratively with the Provider Trainer to ensure provider re-education is scheduled and completed.
  • Following the Episource progressive Disciplinary policy, working with the Director of Clinical Services and Human Resources, guide providers in the region through the process as necessary based on KPI reports or any other disciplinary problem identified.  Completing all necessary documentation as needed.
  • Conduct monthly remote, and twice annual, in-person team meetings for each team and all providers in region.
  • Ensure that all collaborative physician / supervision guidelines and state requirements for NP/PA practice are adhered to.  Schedule, facilitate and document any necessary meetings to meet these requirements.
  • Ensure all diagnostic campaigns in the region are adequately stocked and staffed; work with the Director of Clinical Services and the Provider Trainer and vendor diagnostic testing specialist(s).
  • Review of 100% of completed/submitted HRAs by a new provider for the first week of employment with a one hour, remote or in person review of the documentation with re-education and training as needed
  • Assist in recruiting and interviewing of new provider candidates as needed

Knowledge/Skill Requirements:

  • Current Licensure free of disciplinary actions
  • AANP or AANC Certification
  • CRNP License
  • PA License
  • Approved Specialties: FNP, ACNP, ANP, AGNP (not all-inclusive)
  • Strong attention to detail
  • Ability to work with all levels of the organization
  • Ability to educate others on system applications and functions
  • Ability to multi-task / work independently and be self-motivated to meet deadlines and achieve goals
  • Strong computer skills, familiar with Microsoft office
  • Ability to operate an Apple iPad
  • Strong professional level of knowledge and comprehensive clinical assessment skills in the adult population and chronic disease management
  • Excellent written and oral communication skills. Must be able to communicate effectively with all levels of management.
  • Able to work under pressure in a dynamic environment with tight deadlines

Education/Experience Requirements:

  • Nurse Practitioner
    • Advanced Practice Registered Nurse (APRN) degree, Master’s degree in Nursing (MSN), or higher (DNP or PHD in Nursing)
  • Physician’s Assistant
    • Bachelor’s Degree or Master’s Degree for Physician Assistants from a NCCPA program accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) or its predecessors.
    • PA License obtained after taking the Physician Assistant National Certifying Examination (PANCE).
  • 5 or more years of experience in patient care or clinical work
  • 2 or more years of experience providing home health care visits.
  • 1 or more years of experience in a managerial position directly overseeing NP/PA providers

EEO POLICY STATEMENT:

Episource, LLC provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. Episource, LLC complies with applicable state and local laws governing non-discrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, placement, promotion, termination, layoff, recall, and transfer, leaves of absence, compensation, and training.

Episource, LLC expressly prohibits any form of unlawful employee harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of Episource, LLC employees to perform their expected job duties is absolutely not tolerated.