Clinical Director

Company Overview Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector. Job Summary and Responsibilities Acentra Health is looking for a Clinical Director to join our growing team. Job Summary: The Clinical Director directs and oversees all clinical program activities, emphasizing the need for overall consistency, thoroughness, and accuracy. The primary purpose is to guide the program towards enhanced clinical efficiencies, ensuring that deliverables and assigned contract functions consistently meet the highest standards. This strategic approach aims to strengthen customer relationships and fulfill contractual requirements. The role includes day-to-day oversight, focusing on effective management of the utilization and care management program and ensuring the seamless implementation of clinical contract requirements. Responsibilities Service as the subject matter expert for clinical review areas across various specialties including but not limited to inpatient and outpatient services with the contract scope of work. Provide ongoing coaching, development, and performance support to direct reports while fostering effective communication with staff through various channels, such as one-on-one meetings, team meetings, and interdepartmental meetings. Oversee compliance with operational standards, quality metrics, regulatory and contractual obligations, organizational policies and procedures, and quality monitoring initiatives. Ensure clinical operations comply with contractual requirements by monitoring critical indicators and adjusting processes to address negative variances. Identify opportunities for enhancing operating efficiencies. Contribute to achieving annual organizational priorities and operational indicators. Manage the clinical quality program, encompassing auditing, Quality Improvement Plans (QIPs), and administration of the Local Quality Improvement Committee. Collaborate with senior leadership to oversee contract activities, including service level agreement metrics, processes, staff development, internal training, review process quality, case management effectiveness, deliverables, and budgetary compliance. Perform other duties as assigned. Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules. Qualifications Active, unrestricted Licensed RN in the applicable state or compact state, Bachelor's degree in nursing, healthcare administration or related area is preferred. Extensive experience managing clinical care management (UM) operations. 3+ years' utilization review experience 2+ years' clinical management experience required. Extensive knowledge of federal and state healthcare programs (Medicaid), Indiana Medicaid preferred. Strong verbal and written communication skills are essential Organizational skills and the ability to plan and prioritize multiple assignments are essential. Customer-focused, results-oriented, with the ability to build and maintain relationships with both internal and external customers. Current knowledge of InterQual criteria. Proficient in examining and re-examining operations and procedures, formulating policy, and developing and implementing new strategies and procedures. Demonstrated expertise in managing diverse customer needs. Understanding of URAC standards and processes, as well as state laws regarding utilization activities. Ability to participate as a team member, fostering collaborative decision-making among leadership, committees, teams, or workgroups of diverse composition. Excellent proficiency in Microsoft Office applications and other essential software programs for job functions. Ability to develop, plan, and implement short and long-range goals. Skill in employee development and performance management. Capability to provide technical guidance and leadership to the management team. Why us? We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes. Benefits Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more. EEO AA M/F/Vet/Disability Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law. Experience in Lieu of Degree For non-clinical roles, or when not required by the contract specifically, the Company acknowledges that practical, hands-on experience can provide skills and competencies equivalent to formal education. As such, in cases where a Bachelor's degree may be required, the Company will accept a minimum of six (6) years of directly relevant professional experience in lieu of a degree. In instances where the candidate has an Associate's degree, the Company will accept a minimum of three (3) years of directly relevant professional experience in lieu of the Bachelor's degree. Compensation The pay for this position is listed below. "Based on our compensation philosophy, an applicant's position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level." Pay Range USD $120,700.00 - USD $146,400.00 /Yr. #J-18808-Ljbffr