Clinical Program Manager

Partner with Network Ops on capacity planning and scheduling. Own daily clinical operations for assigned RN/MA programs (e.g., BP), including supervisory activities, team huddles, daily performance review, coverage plans, and service recovery. Provide functional leadership to internal and contractor/vendor assigned RNs and MAs, RN/MA program leads, and RN/MA supervisors. Ensure coverage is distributed to prevent single-point strain and minimize program risks. Ensure RN/MA documentation meets HEDIS/CMS, client, and internal SOP standards. Maintain HIPAA, privacy, and policy adherence across internal and contractor/vendor staff. Maintain a living RACI for programs. Ensure invoice/billing for RN/MA groups monthly. Provide required clinical input on IVR dialer management. Monitor and report on clinical KPIs (staffing levels, real-time performance metrics, capacity constraints, engagement, completion, escalations, documentation, and safety events, or other operational metrics) and trigger corrective actions. Partner with Analytics to produce weekly/monthly clinical metrics reports and ad-hoc deep dives that support internal and client reporting and renewals. Present operational summaries and clinical insights to leadership and clients as requested. Own the quality assurance program for assigned clinical programs, including the design, execution, and continuous improvement of quality monitoring and improvement activities. Own and run the chart-audit program to ensure chart-audit processes are performed per quality standards. Execute AI-enabled chart audit processes per client allowance. Complete chart audits reviewing process and health outcomes related to program goals. Perform retrospective chart reviews of RN/MA (and provider, as applicable) consults, documentation, and care notes. Evaluate documentation for clinical accuracy, completeness, professionalism, and adherence to internal protocols and external standards (e.g., CMS, HEDIS, HIPAA). Identify patterns in documentation deficiencies or clinical deviations and translate them into targeted training or system improvements. Design and maintain sampling plans, run audit tools, and coach to closure with RN/MA teams. Own quality initiatives and feedback loops for continuous improvement, closing the loop between audit findings, education, and program performance. Coordinate RN/MA activities to ensure high-quality completion of: visit intake, referral and order follow-up, result interpretation, genetic test order reviews, and routine chart audits. Ensure RN/MA coverage for required post-consult follow-up and close the loop on outstanding actions. Deliver onboarding, orientation, and skills training for new clinical team members across multiple roles (RNs, MAs, and other clinical staff). Create and update training resources (e.g., presentations, SOPs, job aids), and maintain program quick-refs, scripts, and FAQs for internal use. Coordinate annual refreshes with Clinical Solutions Coordinator. Conduct periodic refresher trainings or workshops based on emerging trends or observed gaps, informed by chart-audit and QA findings. Assist with RN/MA and provider questions regarding workflows, documentation, or standards of care. Collaborate with operations, compliance, and clinical leadership to ensure training materials are aligned with current practice and regulatory expectations. Validate competency via structured knowledge checks and skills assessments. Partner with staffing agency/vendor leadership for contract RN/MA recruitment, quality, staffing, attendance, onboarding and offboarding. Align roles/responsibilities and escalation paths with supervisors. Ensure training cohorts support rapid and high volume staffing needs. Direct and support RN/MA-led outreach to ensure protocol adherence, addressing patient questions about health status, results, treatment plans, and medications as appropriate (phone/virtual) and escalating to provider per protocol. Requirements Bachelor's Degree in Nursing or similar field from an accredited college or university; or equivalent professional experience Licensed Registered Nurse (RN); compact or multistate licensure preferred 5+ years of professional clinical, nursing, or related experience; virtual/telehealth experience preferred Two years or more leading clinical teams or large cohorts in high-volume settings; vendor-partner management experience is a plus Demonstrated experience owning clinical quality assurance, chart-audit, and/or documentation-review programs Demonstrated skill in program operations, workforce coordination and KPI-driven management. Core Competencies Demonstrates expertise in clinical operations management, quality assurance, and documentation review, with a strong focus on compliance with HEDIS, CMS, and HIPAA standards. Proven ability to lead clinical teams, coordinate workforce activities, and drive performance through KPI management. Highest-signal resume keywords Licensed Registered Nurse (RN) Clinical Quality Assurance Chart Audit Management KPI-Driven Management Team Leadership in High-Volume Settings ATS Optimization Keywords Hard Skills Clinical Operations Management Documentation Review Quality Monitoring Capacity Planning Performance Metrics Analysis Training Development Chart Audit Processes Compliance Adherence Vendor Management Clinical Program Coordination Soft Skills Leadership Collaboration Communication Problem-Solving Coaching Certifications & Qualifications Bachelor's Degree in Nursing Compact or Multistate Licensure Industry Keywords HEDIS CMS HIPAA Telehealth Clinical KPIs Service Recovery RACI SOP Standards Quality Improvement Clinical Documentation #J-18808-Ljbffr