Manager, Clinical Care Management (New Mexico)
Candidates must be a resident of New Mexico to be considered for this role.
Who is Comagine Health?
Comagine Health is a national, nonprofit, health care consulting firm. We work collaboratively with patients, providers, payers, and other stakeholders to reimagine, redesign and implement sustainable improvements in the health care system.
As a trusted, neutral party, we work in our communities to address key, complex health, and health care delivery problems. In all our engagements and initiatives, we draw upon our expertise in quality improvement, care management, health information technology, analytics, and research.
We invite our partners and communities to work with us to improve health and redesign the health care delivery system.
Responsibilities
- Provide operational management of clinical staff who provide utilization review, and/or specialty reviews.
- Develop, implement, and maintain departmental policies and procedures, staffing protocols, training programs, quality management programs, and department budgets.
- Ensure that department fully meets all required legal, contractual and accreditation standards as well as compliance with corporate policies.
- Participate in business/product development, proposals and customer relations activities.
- May also conduct prospective, concurrent, and/or retrospective utilization management reviews.
Performance Management
- Conduct performance appraisals with staff using objective data related to job performance and goals/standards established for each position.
- Ensure that all resource materials necessary to conduct daily work activities are made available to staff.
- Ensure that established quality, productivity and attendance standards are met by all staff through regular performance monitoring.
- Develop, update and share job descriptions with staff to clarify job expectations and performance standards.
- Initiate timely and appropriate counseling, education, training and coaching with staff to support professional development or to address areas of performance deficiencies.
- Responsible for all personnel management activities, including supervision, evaluation, hiring and termination, in accordance with company policies.
- Serve as a consultant to staff regarding clinical and/or non-clinical matters, customer expectations, accreditation standards, contractual requirements and utilization activities.
Utilization Management Services
- Accept utilization management assignments when work volumes or case complexities require managerial back up.
- Collaborate with the development and implementation of a quality management program, including an on-going internal quality control (IQC) system.
- Collaborate with medical affairs and staff in developing guidelines and protocols for clinical review staff.
- Develop and implement necessary operational policies and procedures to meet contractual requirements.
- Monitor and maintain adequate access by providers, customers, patients/clients.
- Review Utilization Review reports to ensure compliance with contractual requirements.
Financial Responsibilities
- Develop and monitor productivity standards for staff.
- Develop timely and appropriate budgets to meet contractual requirements.
- Ensure compliance with finance and accounting policies and procedures.
- Initiate timely interventions to improve budget compliance.
- Monitor unbilled hours and open cases/reviews for timely billing.
Customer Relations
- Participate in responses to requests for proposals (RFPs) and other business development activities.
- Promote positive customer service behaviors among staff.
- Provide timely communications with providers, patients/clients, and stakeholders.
- Represent the products/services of the department in customer meetings.
Compliance and Reporting
- Develop, monitor, and report on departmental goals and objectives.
- Ensure timely communication of significant operational issues to management.
- Maintain compliance with organizational policies and procedures.
- Monitor completion of timecards for accuracy and compliance.
Compensation Range: $85,000 - $107,000
Required Skills
- Intermediate MS Office Suite proficiency.
- Working knowledge of Medicaid or commercial insurance preferred.
Required Experience
- Current, active, unrestricted RN licensure.
- BA / BS in a related field.
- Equivalent combination of education and/or work experience may be substituted.
- IQCI or certification in a medical management field preferred.
- At least 5 years of utilization/case management experience.
- At least 2 years of management experience, including financial management.
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