Clinical Operations Manager

Job Title Clinical Operations Manager Exemption Status Exempt Management Level Manager Direct Reports Health System Navigators Manager Title Director, Integrated Services Department 610, Integration Pay and Benefits Estimated hiring range $121,797 - $148,863 / year, 5% bonus target, full benefits. www.careoregon.org/about-us/careers/benefits Posting Notes This is a hybrid role that will require you to occasionally go into the downtown Portland office for meetings. Job Summary This position is responsible for directing and managing clinical and non-clinical staff and resources. Areas of oversight include direction, coordination and monitoring of Health Share delegated care coordination programs. This includes the responsibility for the development and implementation of program standards and procedures, monitoring program impact, and ensuring effectiveness and integrity. This position works closely with and provides guidance to other managers and directors across the organization and Health Share health plan, health system, and county partners to ensure collaboration, integration and support of organizational activities and goals. This position is also responsible for developing state required reporting to the Oregon Health Authority regarding care coordination. Essential Responsibilities Operational Management Direct and oversee the coordination of Care Coordination activities across Health Share system partners, including the development of new reporting, communication, and monitoring activities. Work collaboratively with Health Plan and County leaders to ensure implementation of new State of Oregon rules, as well as procedures to monitor program impact and effectiveness. Develop and implement monitoring programs and services to ensure compliance to the CCO Contract and Oregon Administrative Rules for Care Coordination activities. Ensure Care Coordination policies and procedures meet Division of Medical Assistance Program (DMAP) requirements and the Centers for Medicare and Medicaid (CMS) requirements. Ensure Care Coordination and Navigation program compliance with DMAP, CMS, and other relevant regulatory bodies that oversee health plan operations. Direct and ensure integration of work between Health Share’s system partners; manage changes across Health Share departments, and communications within Health Share, and between partners, and providers. Ensure new OHA risk stratification requirements are implemented at Health Share and at the Health Share plan partners Direct and work with Health Share system partners and health information technology staff in the development of centralized member risk stratification processes Act as a technical and operational resource to Health Share staff and Health Plan and County Care Coordination leadership. Ensure unit work is performed in coordination with other relevant CCO functions; serve as a liaison and collaborator with multiple teams including CCO customer service, claims, appeals and grievances, population health, information systems, and others. Keep current on standards for health plan operations related to Care Coordination and case management. Perform on-going analysis of data and information, looking for opportunities for improvement in appropriate utilization of resources. Frequently communicate with Health System partners to problem solve issues and improve workflows. Monitor Care Coordination utilization and activities at Health Share partners. Program Development, Improvement, and Evaluation Directs Care Coordination teams in development of programmatic guidelines and policy, and ensures these guidelines are followed. Identify opportunities for improvement and participate in their development and implementation, including process improvement initiatives. Develop, utilize and regularly monitor measures/metrics to improve the program’s effectiveness and efficiency of work processes. Create a unit environment that encourages professionalism and teamwork and uses progressive problem solving to meet expectations. Employee Supervision Manage team(s) and recommend team direction and goals in alignment with the organizational mission, vision, and values. Plan, organize, schedule, and monitor work; ensure employees have information and resources to meet job expectations. Lead the development, communication, and oversight of team and individual goals; ensure goals, expectations, and standards are clearly understood by staff. Train, supervise, motivate, and coach employees; provide support toward employee development. Incorporate equity tools into people leadership, planning, operations, evaluation, and decision making. Ensure team adheres to department and organizational standards, policies, and procedures. Evaluate employee performance and provides regular feedback to support success; recognize strong performance and address performance gaps and accountability (corrective action). Perform supervisory tasks in collaboration with Human Resources as needed. Organizational Responsibilities Perform work in alignment with the organization’s mission, vision and values. Support the organization’s commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals. Strive to meet annual business goals in support the organization’s strategic goals. Adhere to the organization’s policies, procedures and other relevant compliance needs. Perform other duties as needed. Knowledge, Skills and Abilities Required Knowledge: Advanced knowledge of managed care concepts and principles Advanced knowledge of health plan regulatory requirements for Medicaid managed care plans Advanced knowledge of basic health plan operations Advanced knowledge of care coordination and case management concepts, principles and practices Knowledge of principles of organizational change and ability to act as a change agent Knowledge of disease management and health promotion principles and processes Core Skills and Abilities: Excellent time management and organizational skills Excellent reading, oral and written communication skills Excellent problem solving and decision-making skills Excellent interpersonal skills Ability to effectively collaborate with medical directors, leadership and staff, and other stakeholders/customers Ability to work well under pressure in a complex and rapidly changing environment Ability to work in an environment with diverse individuals and groups Ability to negotiate skillfully and to build consensus Ability to manage staff, including mentoring staff growth Ability to oversee services involving substantial costs Ability to support and comply with organizational policies, procedures and guidelines Ability to use basic computer programs commonly used for health plan operations Ability to implement projects and to train staff to new processes and procedures Ability to develop and implement procedures and program standards Ability to manage multiple tasks, complex projects, and to delegate as deemed appropriate Ability to work as an effective team member and leader in a complex and fast-paced environment Physical Skills and Abilities: Ability to perform repetitive finger, wrist, shoulder or neck movement for at least 6-8 hours/day Ability to see and read for at least 6-8 hours/day Ability to hear and speak clearly for at least 3-6 hours/day Cognitive Skills and Abilities: Ability to focus on and comprehend information and learn new skills and abilities Ability to assess a situation and seek or determine appropriate resolution Ability to accept direction and feedback, as well as tolerate and manage stress Education and/or Experience Required: Minimum 5 years’ relevant work experience, including management of large projects or initiatives in an area of responsibility listed above, as well as experience working at or closely with a health plan, including detailed knowledge of the Oregon Health Plan (OHP) benefit and the Division of Medical Assistance Programs (DMAP) Minimum 1 year experience in a supervisory or lead position or completion of Health Share’s Aspiring Leaders program within first year in position; lead roles preferably include regular assistance to a manager or supervisor in staff hiring, coaching, performance evaluation, and other supervisory tasks Bachelor’s degree in Nursing or Master’s degree social work, psychology, counseling, or health related field Working Conditions Primary Work Environment: Indoor/Office Member Facing Patient Facing Facilities/Security Other Work Environment(s): Indoor/Office Member Facing Patient Facing Facilities/Security Outdoor Exposure Hazards: General office hazards, which most commonly include potential physical and ergonomic hazards, such as falls, cuts, repetitive strains, accidents, etc. Equipment: General office equipment Travel: This position may include occasional required or optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used. Work Location: Hybrid-Office 2 days/week #Li-Hybrid Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment. Veterans are strongly encouraged to apply. We are an equal opportunity employer. CareOregon considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or veteran status. Visa sponsorship is not available at this time.