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Clinical Program Manager (Remote - Must reside in the state of Alabama) at Keystone Peer Review Organization, Inc. in Birmingham, Alabama

Posted in Nurse 30+ days ago.

Type: Full-Time





Job Description:

KEPRO is a rapidly growing national quality improvement and care management organization. We work to ensure that over 20 million people receive the right care, at the right time, in the right setting. KEPRO is seeking resumes for a highly experienced professional.

Clinical Program Manager (Remote - Must reside in the state of Alabama)

We are excited to announce that we are expanding operations into Alabama, in anticipation of new business in utilization management. We are looking for motivated, energetic individuals to help us stand up this new contract. We want you to help be a vital part of this newly created team! While you must reside in the state of Alabama, the work for this role can be done remotely.

Summary Description 

The Program Manager is responsible for operation of all contract duties to ensure that all contractual obligations are met. The Program Manager coordinates with the Department on decisions and issues and communicates with providers regarding determinations and other clinical matters. The Program Manager also develops and leads clinical staff in activities to facilitate and support clinical, quality, and cost-effective outcomes.

Accountabilities 


  • Oversee, coordinate, and monitor all Clinical team activities for the prior authorization review process.

  • Ensure adequate staffing and contractual service levels are adhered to by implementing and monitoring clinical staff productivity and performance indicators.

  • Maintains effective team member relations.

  • Leads team members in improving skills, creativity, and problem-solving.

  • Serve as liaison between the client and Kepro.

  • Attend Medicaid meetings, fair hearings, and meetings and hearings of legislative committees.

  • Work with management team to develop and enhance the operational structure including skill set requirements, gap analysis, and training using workforce planning.

  • Manages and completes assigned work plan objectives and projects on a timely basis.

  • Provide advice and assistance to leaders in the planning, implementation, and evaluation of modifications to existing operations, systems, and procedures. Collaborate with leadership in the development of new and enhanced products and services.

  • Represents the clinical department by participating on committees, task forces, work groups, and multidisciplinary teams.

  • Maintains professional relationships with provider community and external customers and identifies opportunities for improvement.

  • Participates in the development of policies and oversees clinical staff activities to ensure compliance with regulatory and accrediting standards, quality assurance and inter-rater reliability.

  • Provides reports of compliance and oversight and reporting of contract required Service Levels.

  • Maintain a positive relationship with our client, by developing ongoing communication and collaborative approach to delivery expectations.

The list of accountabilities is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary from time to time. 

Qualifications 


  • Bachelor’s Degree in Nursing Required, Master’s in Nursing or other health-related field preferred.

  • Active unrestricted, RN license.

Knowledge, Skills, Abilities 


  • Demonstrated proficiency in MS Office applications.

  • Ability to maintain a positive attitude and contribute both as an individual and a team member to achieve the goals of the department.

  • Ability to professionally respond to change and handle multiple and changing priorities with sometimes conflicting deadlines.

  • Knowledge and willingness to become a subject matter and thought leader for designated program(s).

  • Knowledge of NCQA/URAC standards strongly preferred.

Experience 


  • 5+ years of clinical experience or equivalent.

  • 5+ years staff/workload management experience, strongly preferred.

  • Experience with stated State Medicaid program (Alabama UM program).

  • Experience working with vulnerable populations, strongly preferred.

  • Experience with retrospective medical reviews (for nursing facilities, ICFs, PRTFs, and SNFs.), strongly preferred.

Mental and Physical Requirements               

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations will be made as required by law in an attempt to enable an individual with a disability to perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit for prolonged periods of time; key and/or control objects; interact extensively with internal and external customers; occasionally lift and/or move objects weighing up to 10 pounds; and occasionally travel within the state.

KEPRO offers challenging careers, excellent benefits and opportunities for advancement.  For consideration, please submit resume and cover letter with salary requirements. Only those candidates identified for an interview will be contacted. No Phone Calls Please.  Visit our website at www.KEPRO.com for more information on the KEPRO Family of Companies.   

EOE AA M/F/Vet/Disability

KEPRO is an Equal Opportunity Employer.  All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)

See job description





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