Acentra is looking for a Clinical Director to join our growing team.
Job Summary:
The Clinical Director is responsible for the management and oversight of Arkansas Utilization Management Contract activities within clinical, contractual, and budgetary parameters. This position directs and oversees all clinical program activities to ensure overall consistency, and accuracy of the clinical programs and ensures clinical efficiencies, deliverables and provide day-to-day oversight to manage multiple areas of the UM program and oversee the implementation of clinical contract requirements and Medicaid rules and regulations.
Job Responsibilities:
- Responsible for UM reviews such as: Inpatient (Under 21) and Outpatient Behavioral Health, Pediatric Developmental Disability Services, Personal Care Services, Applied Behavioral Analysis and Dental program.
- Advises and manages direct reports relative to their responsibilities for utilization management review; including but not limited to operational standards and quality outcomes, regulatory and contractual compliance, policy and procedures and quality monitoring, and adherence to Medicaid rules and regulations.
- Ensure compliance with contractual requirements within the clinical operation by monitoring critical indicators and adjusting processes to compensate for negative variances.
- Identify areas to improve operating efficiencies.
- Serve as a Subject Matter Expert (SME).
- Assists in achieving annual organizational priorities and operational indicators.
- Foster and maintain strong communications with staff through various means; e.g., one-on-one meetings, team meetings, and interdepartmental meetings.
- Responsible for clinical quality program to include auditing, Quality Improvement Plans (QIP's) and administration of the Local Quality Improvement Committee.
- Identify problems caused by software glitches and flaws and work with IT and staff to resolve the problem.
Required Qualifications/Experience
- Active, unrestricted Licensed in one of the following: RN in Arkansas or compact state, Social Work, Licensed Professional Counselors, PT, OT and ST
- Bachelor's Degree or equivalent directly applicable experience in nursing, healthcare administration or related area, Master's level is preferred.
- Knowledge of Arkansas and Federal Medicaid rules and regulations.
- Current working knowledge of utilization management, case management, and managed care.
Additional Qualifications/Experience:
- Skill in examining and re-examining operations and procedures, formulating policy, and developing and implementing new strategies and procedures.
- Knowledge of U.S. healthcare industry
- Experience in using systems that support Utilization and Case Management processing
- Understanding of URAC standards and processes
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