Jobs and Careers

Regional Manager, Clinical Services

United States, United Statesfull_timeVerifiedPosted 12 Mar 2025

About the role

Position Summary
The Regional Manager Clinical Services will be responsible for planning, directing, and overseeing the performance of a team of assigned Provider and Member facing staff. The position will oversee the administrative, clinical, and quality activities related to building strong provider and member engagement and health outcomes.

Responsibilities

Function as ambassador for organization with all internal and external customers
Collaborate as needed with team to help engage providers and members and serve as escalation point for difficult practices and/or members
Implement organization policies, procedures, workflows, and action plans to drive team performance
Ensure collaboration and communication among multi-disciplinary teams to ensure they are coordinated in working toward maximum customer engagement and improved member outcomes
Monitor Key Performance Indicators (KPIs) to identify trends and areas of opportunity that will guide regional strategy; Develop action plans and/or remediation strategies to address areas of opportunity
Develop, monitor, and report on team performance and productivity
Monitor practice profiles monthly to ensure that practices with newly attributed members are appropriately assigned to a PRT
Troubleshoot technical issues within Compass and/or Tableau as needed
Promote an environment of continuous improvement through on-going team audits, provider practice visits, and monitoring of member calls to identify gaps in teams’ skills and competencies; Work to develop ongoing team education to address areas of opportunity
Develop, coach, and mentor team members to achieve company, department, and individual goals
Conduct yearly performance evaluations and provide constructive feedback to redirect team members with a positive discipline approach
Maintain team performance according to National Committee for Quality Assurance (NCQA) standards including but not limited to appropriate provider and member documentation
Comply with HIPAA privacy laws, all other federal and local regulations, and company security policies
Provide recommendations to the leadership regarding necessary operational adjustments needed to ensure organizational objectives and goals are met
Perform other related duties as assigned

Requirements

Bachelor's degree in nursing required; master’s degree preferred
Active RN licensure required
Minimum of two years progressive supervisory and/or management experience required
5 years of progressive experience in healthcare services, clinical operations, quality, or care management required
5 years of experience in closure of care gaps or care coordination preferred
Prior experience building and managing relationships with health care providers or patients preferred
Must reside in Regional Territory
Proof of valid and unrestricted driver’s license required

Skills

Excellent verbal, written and presentation skills
People skills to develop and maintain strong internal and external relationships
Ability to multitask, prioritize, and create solutions in a challenging environment
Demonstrated leadership skills and ability to create and maintain a positive work environment
Strong critical thinking and analytical skills
Ability to foster strong employee engagement among the team
Must be proficient in Microsoft Office: Outlook, Word, Excel, PowerPoint

Travel
Moderate Travel, 25% to 50%

#LI-Hybrid