Manager, Clinical Quality Operations

This position is remote

We are more than just a healthcare company; we are a community of professionals driven by the knowledge that our success leads to a positive impact on the communities that we support.

 At ComplexCare Solutions, you’ll play a crucial part in innovating solutions that empower health plan members and healthcare providers alike. Our collaborative environment fosters creativity and initiative, ensuring that every idea and effort contributes to meaningful change in the industry. Join us and become a part of a team that turns vision into action, making a tangible impact on the future of healthcare.

Overview:  The Manager, Clinical Quality Operations will be responsible for field oversight of our in-home assessment Nurse Practitioner and Physician Assistants. The focus of this role is on the day-to-day delivery of excellence in the quality of care, ensuring all clinical and operational policies and procedures are followed, and production targets are met.

Duties and Responsibilities:

• Manage large network of field-based mid-level practitioners;
• Partner with department leaders in strategic planning and review of dashboards and reporting to drive operational excellence;
• Conduct 1:1 check ins with your providers at least twice a month to include a review of their current performance and any necessary coaching;
• Review the results of audits of medical records performed by the Clinical Auditor;
• Review clinical monitoring reports for trends or individual issues;
• Develop/Review the clinical resource scorecard that summarizes the results of audits, clinical monitoring and operational monitoring reports for trends and individual issues;
• Provide specific one-on-one coaching on quality issues identified in review of the clinical resource’s audit results;
• Identify clinical resources requiring referral to a remediation training course;
• Identify clinical resources whose performance warrants referrals for a Quality Improvement Program;
• Assume role of clinical resource when questions arise in the field;
• Prepares documentation tracking coaching efforts and results of coaching efforts;
• In conjunction with the clinical training team, identify training needs, contributes to training material development, and support its implementation;
• Participate in key organizational meetings providing details specific to audit activity and outcomes;
• Maintain compliance with CCS’s policies, procedures and mission statement;
• Adhere to all confidentiality and HIPAA requirements as outlined within CCS’s Operating Policies and Procedures in all ways and at all times with respect to any aspect of the data handled or services rendered in the undertaking of the position; and
• Fulfill those responsibilities and/or duties that may be reasonably provided by CCS for the purpose of achieving operational and financial success of the Employer.

Job Requirements:

• Minimum of 5 years of management experience desired with an interest in Healthcare Field and Career;
• Goal oriented, results focused and self-motivated;
• A self-starter; ability to work in a Team Environment;
• Ability to create a positive and motivating work environment;
• Excellent written and oral communication skills;
• Ability to organize his/her time and work without direct and daily supervision;
• Strong interpersonal and organizational skills;
• Ability to work in a fast-paced environment and prioritize tasks to meet deadlines and goals.  
• Knowledge of Microsoft Office Products, particularly Outlook and Excel; and
• Ability to exercise independent judgment within policy and procedure guidelines established by the company.
• Travel for this position will include less than 5% locally usually for training purposes.

Education:

• Bachelor’s Degree;
• Must have current clinical license; RN preferred

ComplexCare Solutions offers an attractive compensation and benefits package designed to support our employees.

The Company is proud to be an equal opportunity workplace and is an affirmative action employer. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, veteran status, or any other protected characteristic under federal, state, or other applicable laws.

This company utilizes E-Verify.