Clinical Director

About the role

Acentra Health is seeking a Clinical Director to lead and oversee all clinical program activities. The role involves guiding the program towards enhanced clinical efficiencies, ensuring deliverables and contract functions meet the highest standards, and contributing to organizational priorities.

Responsibilities

• Service as the subject matter expert for clinical review areas across various specialties including inpatient and outpatient services.
• Provide ongoing coaching, development, and performance support to direct reports.
• 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.
• 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.
• 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 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.
• Skill in employee development and performance management.
• Capability to provide technical guidance and leadership to the management team.