Clinical Manager, Navigation Service Delivery

ROLE

We’re looking for a Clinical Manager, Navigation Service Delivery & Innovation. This individual will lead our team of Clinical Health Guides (registered nurses) who help our members navigate their healthcare needs, e.g., clinical triage, education, clinical guidance, treatment decision support, condition support, and overall well-being, in driving more informed healthcare consumers, improving clinical outcomes, and reducing overall healthcare costs. 

This manager is accountable for the day-to-day management of the clinical navigation business group, leading and motivating a team of Clinical Health Guides to deliver impactful, timely, accurate, and high-touch concierge-level clinical guidance to our members. The Manager is responsible for delivering against operational KPIs, driving quality, handling resolution of member/client escalations, and overall support of their team operating in our Rightway omnichannel contact center environment.

This manager, in collaboration with delivery leadership, will work cross-functionally, collaborating across the organization to drive clinical operational innovation, clinical outcome impact, and product efficiency. This includes supporting our customer success team with client-facing reporting of clinical insights and impact, as well as clinical/point solution vendor assessment and partnership oversight.  

RESPONSIBILITIES

• Lead, motivate, coach, and mentor your team of Clinical Health Guides to deliver world-class concierge-level clinical guidance in a care navigation contact center environment. 
• Support team with complex clinical navigations (member encounters) and offer clinical insight, guidance, and support. Leaning in to support with medical navigations and other workflows as needed during peak season or as needed based on volume and staffing. 
• Escalation management, including resolving member issues, root cause analysis, developing solutions, and communicating resolution plans to key stakeholders and clients as needed.
• Interview, hire, onboard, train, audit, and ensure team member adherence to Rightway care navigation model, triage and clinical protocols, and use of clinical tools, e.g., 5-Minute Consult, ClearTriage, compliance with policies, procedures, and regulations (HIPAA, etc.).
• Assign, review, and monitor employee workload to ensure the timely and accurate completion of member interactions. Conduct weekly coaching sessions, quality reviews, and performance evaluations. 
• Perform daily, weekly, and monthly reviews of performance analytics to drive member experience, identify process improvements, and otherwise manage the business.
• Develop, update, and maintain Standard Operating Procedures. 
• Develop evidence-based clinical protocols and workflows.
• Serve as the internal primary clinical point of contact and subject matter expert for the organization  (Account Mgmt., Product, Data & Analytics, Sales, etc.)
• Support new/renewing client launches.
• Work collaboratively in cross-functional teams to drive operational and product improvements, growth, and efficiency through partnerships with the navigation leadership, PBM delivery team, CMO, product, and data/analytic teams. 
• Supports the client success team with client requests and needs requiring clinical expertise.
• Supports the client success team, as needed, with client quarterly business reviews in providing clinical insights and impact for their population.
• Responsible for evaluating strategic clinical partner vendors as well as oversight and management of our clinical vendor partners, e.g., after-hours nurse line, telemedicine, etc. 

REQUIREMENTS

• Must have a Registered Nurse or Advanced Practice Registered Nurse active, valid license, and must have a multi-state/compact license. This candidate should have experience as a nurse manager, program administrator, and in running clinical programs.  
• Experience developing and executing on public health and/or population health strategies and programs.
• Demonstrated and direct nurse management experience or equivalent experience required.
• Disease Mgmt and/or Case Mgmt program experience is highly desirable. 

• Strong and demonstrated coaching and mentoring skills with a passion for developing and growing team members.
• High level of Emotional Intelligence (EQ).

• Growth-oriented, coachable with a focus on continued professional growth and development.
• Requires a flexible work schedule, including evenings and weekends as needed
• Strong team-buildin