-Education/Experience: Bachelor’s Degree in Nursing, International Medical Graduate, Master’s Degree in Public Health (MPH), Hospital Administration (MHA) or Business Administration (MBA) .
-Five to seven years managed care, hospital or medical group experience, focusing on quality improvement, utilization management, or clinical operations
-Project management experience at a medical group, IPA, or health plan setting.
-Experience analyzing and presenting data to drive outcomes.
-Experience making presentations in group settings.
-At least two years management experience
The Clinical Program Manager is responsible for identifying, managing and tracking clinical, quality, correct coding, documentation and data submission projects that advance the objectives of the company's strategic goals. The Clinical Program Manager facilitates the development of internal and external reports and the delivery of data as needed to support and monitor the action plans to accomplish the Triple Aim: 1) to improve member experience, 2) improve the quality of care and 3) to reduce health care costs.
Responsible for managing and tracking clinical projects that advance the objectives of strategic plan with key provider groups and/or hospital systems by supporting established committees and creating new work teams; including such activities as organizing and publishing agendas, documenting minutes, maintaining work plans and monitoring open action items
Works closely with the Regional Medical Director to analyze data and develop and implement key interventions to support the Triple Aim, including developing work plans, workflows, policies and procedures, and serving as workgroup leader when appropriate in order to execute initiatives.
Serves as project leader for cross functional initiatives that are intended to drive performance improvement engaging across functional teams as needed to ensure effective communication of project requirements, as well as tracks progress of action plans.
Facilitates the development of clinical reports and the delivery of data to key provider partners; as well as develops internal reports to demonstrate progress.
Performs detailed analysis of data, workflows, policies, procedures and organization of staff, in order to execute initiatives.
May use project management software to support initiatives.
-Education/Experience: Master’s degree in Psychology, Social Work, Counseling, or Nursing.
-Five to seven years of prior managed care experience and/or experience working with provider groups preferred.
License/Certification: Licensed behavioral health clinician (LMFT, LCSW, LPC, Psychologist) or RN with experience in a psychiatric setting required.