RN Clinical Operations Manager - (Hybrid Position in…

Following a 2022 merger of CNSI and Kepro, Acentra Health combines clinical services, technology solutions, and data analytics to accelerate better health outcomes. This is a great time to join our team of passionate individuals working together to pursue the most effective solutions to today’s complex healthcare challenges. Our culture is fueled by passion and driven by purpose.
Position Overview
As a RN Clinical Operations Manager, you will lead the charge in overseeing Clinical Operations, including Utilization Management, and Case Management functions for Medical and Behavioral Health Services. This pivotal role encompasses a multifaceted approach, involving the development and enforcement of operational policies and procedures. Demonstrated experienced with staff supervision and development, establish and oversee Physicians Contractors, as part of medical necessity review processes. You will be closely involved with State Contractors and Program Stakeholders. Embrace the opportunity to drive efficiency in healthcare operations, making a tangible impact on the quality of care provided and the overall success of the organization.
Job Responsibilities
Coordinate and direct Clinical Operations and associated programs, while directly supervising clinical support staff to ensure optimal performance and adherence to established protocols.
Develop and maintain robust procedures and practices to effectively achieve departmental or program goals and objectives, fostering a culture of continuous improvement and excellence.
Adept at managing stakeholder and physician relationships while ensuring compliance with programs and policies.
Monitor key business and financial metrics pertinent to daily operational success, reporting progress and assessing performance through regular reviews to drive strategic decision-making.
Take charge of clinical operations, including program coordination, scheduling, work plan management, reporting, and issue resolution tracking, ensuring smooth and efficient workflows.
Demonstrate leadership and sound decision-making abilities to maintain continuity and operational effectiveness.
Proactively address program or departmental operations issues, either resolving them directly or delegating to appropriate personnel for prompt and effective resolution, fostering a culture of accountability and problem-solving.
Required Qualifications, Skills, Knowledge and Experience
Bachelor’s degree and a minimum of 5 years of relevant experience, or an equivalent combination of education and experience.
Active unrestricted RN license in the State of West Virginia as per contract requirements.
Minimum of 3 to 5 years of management experience in a health care setting.
Case Management Certification is preferred.
5 years of clinical experience, with a focus on utilization review for at least 3 years, demonstrated expertise in optimizing resource allocation and quality of care.
Minimum of 1 year of experience performing quality audits, evaluating processes, and developing improvement plans.
Proficiency in navigating and effectively contributing within the company’s decision-making and organizational structure.
Manage a Physician Consultants Review Panel through criteria development for all review areas when deemed neccessary. Execute and maintain physician contracts with Corporate, hold Physician quarterly meetings, IRR Physician activities and act as a liaison with corporate for Physician credentialing.
Provide Physician training on systems usage and corporate compliance.
Skilled in evaluating and refining operational procedures, policy formulation, and implementing innovative strategies to enhance efficiency and effectiveness.
Proven track record in employee development and performance management, fostering a culture of continuous improvement and professional growth.
Ability to operate as a subject matter expert related to medical and behavioral health utilization management operations while driving operational optimization.
Aptitude for managing change, navigating complex organizational dynamics with resilience and adaptability.
Proficiency in strategic planning and cultivating strategic partnerships to drive business success.
Expertise in managing diverse customer needs, with a strong focus on delivering exceptional service and satisfaction.
Adept at fostering collaborative decision-making and communication among diverse leadership, committees, and workgroups.
Singularly Focused. Mission Driven.  
Accelerating Better Outcomes is our Mantra! We are mission-driven to innovate health solutions that deliver maximum value and impact.
We do this through our people.
You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.
Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.
Compensation
The compensation for this role is $75,000.00 - $82,000.00 annual salary. Based on our compensation program, an applicant’s position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level.
EOE AA M/F/Vet/Disability
Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.
We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search!
~ The Acentra Health Talent Acquisition Team