Job Description

Position Summary:

The Clinical Project Manager works directly with the Campus Medical Director towards enhancing our members' overall health. They are responsible for participating in daily patient care rounds and interdisciplinary team meetings and will assist in implementing care plans. They will review discharge plans for thoroughness and completion, working with internal teams to ensure all referrals have been placed. The clinical Project Manager links the Medical Director, inpatient case manager, inpatient coordinator, behavioral health, patient advocacy, social work, member services, and other stakeholders involved in the inpatient care of our members. The Clinical Project Manager will communicate frequently with contracted physicians to discuss metrics and strategies to improve health outcomes. They will analyze utilization data to assess for trends and plan interventions accordingly. They will evaluate actions continually, adjusting to meet the needs and goals of the company. The successful Clinical Project Manager will bring internal teams and contracted physicians together to provide efficient, cost-effective, patient-centered care to our members. The Regional Medical Director will be responsible for annual reviews and employment oversight.

Essential Duties and Responsibilities include the following:

• Coordinates activities from the various stakeholders (the patient, family members and friends, hospitalists, inpatient case management, PCP, visiting physicians and nurses and others) to create a seamless patient experience of transition of care.
• Develops, monitors, and analyzes reports and identifies trends to develop programs and processes that improve program outcomes.
• Identifies and assists in the development of Concurrent Review policies and procedures and assists the Medical Director to oversee compliance and consistency of the program that meets RMG and regulatory standards.
• Assists with the development and implementation of training plans for new and existing staff.
• Acts as a resource for clinical staff for case review and discharge planning.
• Develops and coordinates strategies across the continuum of care for ensuring the delivery of care in the most cost effective setting.
• Collaborates with management to analyze data and implement programs that will improve patient outcomes.
• Develops annual department goals and objectives focused on improving patient outcomes and department efficiency.
• Acts as a role model for staff appropriate case manager and customer service behaviors.
• Works collaboratively with the entire Medical Management team to ensure compliance with regulatory and health plan requirements.
• Develop working relationships with hospital case management departments to facilitate timely reviews.
• Works closely with other departments (claims, finance, high risk, CM, TOC) as needed.
• Assumes other responsibilities as assigned.
• Anticipate our customer needs: Understand the wants and needs of customers, listen for cues and identify how to respond and what level of intervention they need.
• Survey the customer’s environment and take appropriate action.
• Refrains from discussing personal business in front of the customer or speak a foreign language different from the customer’s language.
• Greets patients, family members, and visitors, physicians in a positive manner by introducing self, speaking clearly and with confidence.
• Returns phone calls to customers and follows up with requests.
• Keeps patient/family member or other customer informed and requests if further assistance is needed.
• Assists others and supports the team.
• Demonstrates the ability to follow through with requests, sharing of critical information, and getting back to individuals in a timely manner.
• Demonstrates honesty and integrity in everyday activities.
• Protects privacy for both patients and employees; ensures information sensitive papers, charts, and reports are not in view of the public.
• Recognizes when an error has been made and immediately reports to appropriate manager.
• Participates in “service recovery” through follow-up with an upset customer, gathering information, and demonstrates empathy.
• Treats patients and their families with respect and dignity. Identifies and addresses psychosocial, cultural, ethnic, and religious/spiritual needs of patients and their families. Functions as Project Manager between administration, patients, physicians, and other healthcare providers.
• Interacts professionally with patient/family/providers and involve patient/family/providers as appropriate.
• Communicates appropriately and clearly to management, co-workers, and physicians.
• Communicates using age appropriate language.
• Understands and applies principles of adult learning methods as they relate to health care educational needs.
• Consults other departments as appropriate to provide for an interdisciplinary approach to the patient’s needs.
• Maintains quality monitors as determined by the Utilization Management and Quality Management Committees and RMG Management.
• Responsible for orientation, instruction/training of new personnel.
• Pursues additional education (in-services, seminars, self-study, and formal education programs) to advance nursing skills and knowledge.
• Documents appropriately pertinent information completely, in the authorization system according to nursing standards and policies.
• Participates in the efficient, effective, and responsible use of resources such as supplies and equipment.
• All other duties as directed by management.

Education and/or Experience:

• Clinical Experience necessary (RN, NP, PA, pharmacist, etc.)
• 3+ years of Project Management Experience in Healthcare/Managed Care preferred
• Minimum 2 years of case management experience preferred
• High-level knowledge of Concurrent Review/Case Management processes and principles
• Prior experience in an MSO environment preferred.
• Ability to work with all levels of management.
• Must have excellent communication skills, both verbal and written.
• Must have excellent organizational skills.
• Prior experience with project development and implementation preferred.
• Required to travel to meet with contracted physicians.
• Requires a current CA driver’s license and car insurance.

The pay range for this position at commencement of employment is expected to be for an RN $104,000 annually ; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

Full Time Position Benefits:

The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.

Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.

Health and Wellness:

• Employer-paid comprehensive medical, pharmacy, and dental for employees
• Vision insurance
• Zero co-payments for employed physician office visits
• Flexible Spending Account (FSA)
• Employer-Paid Life Insurance
• Employee Assistance Program (EAP)
• Behavioral Health Services

Savings and Retirement:

• 401k Retirement Savings Plan
• Income Protection Insurance

Other Benefits:

• Vacation Time
• Company celebrations
• Employee Assistance Program
• Employee Referral Bonus
• Tuition Reimbursement
• License Renewal CEU Cost Reimbursement Program
• Business-casual working environment
• Sick days
• Paid holidays
• Mileage

Job Tags

Similar Jobs