Clinical Program Development Manager, Care Management - 25-14

Primed

Country: United States of America

Location: San Ramon, California

Time Type: Full time

Posted On: January 22, 2025

We’re delighted you’re considering joining us!

At Hill Physicians Medical Group, we’re shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members.

Join Our Team!

Hill Physicians has much to offer prospective employees.  We’re regularly recognized as one of the “Best Places to Work in the Bay Area” and have been recognized as one of the “Healthiest Places to Work in the Bay Area.” When you join our team, you’re making a great choice for your professional career and your personal satisfaction.

DE&I Statement:

At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are.

We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right!

Job Description:

The Clinical Program Development Manager of Care Management is a member of the PriMed Hill Physicians departmental clinical leadership team. This position is responsible for developing, leading and implementing evidence-based clinical protocols and staff competency training that are relevant to the HPMG strategic initiatives.  Monitors all programs to care management.  In collaboration with PCPs, care management leadership team, oversees the clinical quality of care delivery of the multi-disciplinary care coordination team.  Responsible for providing input into the clinical direction and consultation of the care management program at PriMed Hill Physicians. The Clinical Program Development Manager develops care management policies, procedures, staff competencies, training, and monitoring care delivery. This position is responsible for the oversight of the performance improvement and maintenance of performance improvement initiatives across the entire care management team.

This position reports to the Director of Care Management, has extensive clinical experience working in acute and primary care environments and has demonstrated work experience with diverse populations with chronic disease, e.g., DM, COPD, Asthma, multiple co-morbid conditions including mental health, substance use and/or behavior health issues, and population health.

Job Responsibilities

  • Collaborate with Care Management Directors and leaders in all regions to implement departmental strategic plans, goals, objectives and deliverables; routinely monitors progress and accomplishments; implement initiatives to improve resource utilization, efficiency and quality of service delivery and work flows.
  • Assists and contributes to the development and distribution of reports (program descriptions, work plan, program evaluation, and progress reports) as required by department.
  • Assist managers and supervisors in the monitoring of clinical interventions for relevancy, timeliness, and effectiveness and assures compliance with regulatory bodies. In addition, conduct audits monitoring clinical documentation for appropriate and timely tracking, objective, concise and legally defensible documentation reporting in software.
  • Develops and maintains a comprehensive orientation and competencies program for Care Management. Evaluates and initiates corrective action to assure clinical and operational excellence.
  • Ensure all staff members are appropriately trained and are routinely evaluated for skill competencies. 
  • Collaborate with Director, CM staff, HRM management, and education resources to establish staff competencies and develop mechanisms professional development.
  • Work with supervisors to monitor high-risk/high-cost/high-utilizing patients; assure appropriate care in appropriate settings and facilitating necessary interventions and referrals for complex Care management and other community supportive programs.
  • Support change management efforts in integrating health care delivery systems, such as process redesign, work restructuring, technological innovations that focus on evidence-based and outcomes driven CM.
  • Participate with Clinical IT system development and design required to support documentation and reporting for CM clinical activity.
  • Create a work environment that fosters professionalism and patient-centered care, respect, and positive morale.
  • Implement departmental policies and procedures that comply with all applicable laws, regulatory agency requirements, health plan delegation and accreditation standards, standards of practice, and organizational service, quality and safety standards.
  • Participate in the departmental budget planning process; adhere to approved budget.
  • Collaborate with PriMed departments, medical leadership and network providers.
  • Represent Care Coordination on inter-departmental committees as appropriate

Required Experience

  • Minimum 5 years of direct acute or primary care clinical experience.
  • Thrives in rapidly evolving environments with high degree of flexibility and change.
  • Demonstrated experience in evidence-based development of policy procedure, standard protocol development.
  • Attentiveness to detail, exhibiting self-direction, high degree of independence, judgment and discretion, teaching ability, effective oral and written communication skills, demonstrate ability to work effectively with others as a team member.
  • Demonstrated ability to create high-performing teams.
  • Must demonstrate customer service skills appropriate to the job.
  • Ability to establish and maintain effective working relationships with internal and external stakeholders across the health care delivery system.
  • Ability to establish and maintain effective working relationships with internal and external stakeholders across the health care delivery system.
  • Excellent written and verbal communication skills in English; must demonstrate ability to effectively communication with staff and management.
  • Demonstrated computer skills in MS Office programs including Word, Excel, and Outlook, electronic CM software.

Preferred Skills and Experience

  • Minimum 3 years management experience in a managed care setting
  • Management training and/or demonstration via work experience
  • Demonstrated experience working with complex-high diverse acuity patient populations.
  • Strong and demonstrated skill in CM, CCR, UM knowledge and experience in a healthcare e.g. inpatient and/or outpatient utilization management, discharge planning, complex Care management.
  • Demonstrated ability to effectively manage change and conflict resolution and problem-solving skills.

Required Education

  • Active unrestricted California RN license
  • Advance practice degree, NP, CNS, DNP degree in Nursing or equivalent combination of experience and education

Preferred

  • Care Management Certification
  • Utilization Management Certification

Additional Information

Salary: $121,000 - $150,000 Annual

Hill Physicians is an Equal Opportunity Employer