Clinical Manager - (Remote & Must Reside within the Central or Eastern Region)

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. 

As the Registered Nurse Clinical Manager, your role is pivotal in leading and overseeing the day-to-day operations of the designated Case Review Teams. You will embody the spirit of mentorship, coaching, and training, uplifting team members to excel in the case review process, thereby assuring the highest standards of quality and meeting contractual obligations. Your role demands the application of independent judgment, leveraging your profound clinical expertise, communication prowess, and problem-solving skills to navigate complex scenarios. This ensures the achievement of optimal outcomes for our clients, in alignment with both payer and client specifications.

You will be the cornerstone of collaboration, working synergistically with healthcare team members across the board, both internally and externally. Your leadership is critical in supporting our interdisciplinary team, with a relentless focus on adhering to contractual, regulatory, and accreditation frameworks. Your commitment to delivering accurate and timely data, coupled with effective communication, will drive our mission forward, ensuring excellence in patient care and operational success.

This position requires the selected candidate to work Monday - Friday from 9:00 AM - 5:30 PM Eastern Standard Time. Some on-call time may be required in the evenings and on weekends. 

Job Responsibilities:

• Leadership and Development: You will supervise, mentor, coach, and develop the case review team within the clinical domain of case review and dispute resolution. It's crucial to ensure the team's high clinical expertise and performance, embracing a compassionate leadership approach throughout the case review process.
• Team and Workload Management: Manage team assignments effectively, evaluating and addressing workload to align with departmental demands and contractual obligations. Your role involves measuring outcomes and making personnel decisions as needed, applying your in-depth knowledge of case review principles.
• Staff Development: In collaboration with leadership, identify the ongoing educational needs of case review staff. Develop and execute plans for orientation and continuous learning to enhance team competencies.
• Quality and Compliance: Lead quality monitoring activities to pinpoint areas for improvement in team performance, processes, and overall quality initiatives. Ensure adherence to regulatory standards, accreditation requirements, and contractual agreements.
• Program Support: Engage in the development, evaluation, and revision of case review tools and methodologies to bolster the effectiveness of case review programs.
• Communication: Maintain open lines of communication with all relevant parties, promoting smooth information flow within the care team. Ensure documentation and reporting are both accurate and timely.
• Confidentiality and Compliance: Uphold the highest standards of client confidentiality and adhere strictly to all organizational, state, and federal privacy regulations.
• Contract Management: Actively participate in contract management activities and oversee the fulfillment of contract administration responsibilities.
• This list of responsibilities is not exhaustive and may be expanded to include other tasks as deemed necessary by management.
  

Required Qualifications, Knowledge, Skills, and Experience:

• Must possess an active, unrestricted RN license.
• A Bachelor’s degree in nursing or a related field is preferred.
• Commitment to ongoing education, certification, and self-improvement is essential to stay abreast of current case review standards.
• A minimum of 5 years of clinical experience in a medical setting is required.
• Experience in quality management, including involvement in projects, reporting outcomes, or other Quality Improvement Programs (QIP).
• Demonstrated experience in case review processes adhering to evidence-based practice standards.
• Familiarity with the No Surprises Act and Dispute Resolution processes.
• Proven workload and client management experience.
• Strong leadership and supervisory skills with a recommendation for Independent Dispute Resolution expertise.
• Exceptional skills in fostering team unity and motivation.
• Outstanding verbal and written communication skills, complemented by