Clinical Program Manager

About TruHealth

TruHealth supplies contracted nurse practitioners and physician assistants to skilled nursing facilities in six states. TruHealth clinicians collaborate with facility providers and administrators to address the full range of patients' medical, mental health and social needs. In addition to providing routine healthcare services, TruHealth providers also act as care coordinators for individuals enrolled in Institutional Special Needs Plans (I-SNPs), a type of Medicare plan for nursing home residents. TruHealth is a division of Franklin, Tennessee-based American Health Partners Inc. To learn more, visit OurTruHealth.com

The purpose of this position is to be responsible for supporting cost-effective, high-quality health care for patients enrolled in the long-term care facilities in their region by managing the activities of a team of Providers and supports national clinical strategy and leadership. The Program Manager is responsible for conducting clinical audits of the providers to ensure excellent service deliver, and that care is administered in accordance with Medicare, Medicare Advantage, and all other compliance programs, state laws and regulatory compliance, privacy and security, detecting, preventing, and correcting fraud, waste, and abuse.

JOB SUMMARY:

The Clinical Program Manager is responsible for supporting cost-effective, high-quality health care for patients enrolled in long-term care facilities within a designated region by managing the activities performed by a team of Providers and to support national clinical strategy and leadership. This position is responsible for conducting clinical audits of the providers to ensure excellent delivery of service and verifying that care is administered in accordance with all compliance programs, Medicare, Medicare Advantage, state laws and regulatory compliance, privacy and security.

ESSENTIAL JOB DUTIES:

To perform this job, an individual must perform each essential function satisfactorily, with or without a reasonable accommodation.

• Work closely with the leadership at the long-term care facilities in their region and company leadership to meet the key performance metrics for a market
• Directly manage a team of Providers and RN Case Managers who provide care within nursing facilities
• Ensure all patient services are delivered timely, effectively and within the scope of the plan
• Collaborate with colleagues to explore innovative delivery models or enhancements to current delivery models and care

practices

• Identify opportunities for process improvements and staff education to produce optimal outcomes
• Serve as a subject matter expert (SME) on the institutional special needs plans (I-SNP) and care model
• Collaborate on the development of training materials to support clinical training
• Participate in clinical training initiatives
• Collaborate with business leaders to implement new markets and programs
• Review daily, weekly and monthly management reports to monitor and manage care delivery
• Collaborate with vendors and community organizations for improved service delivery
• Oversee the review and resolution of complaints and grievances
• Participate in company-wide initiatives to ensure consistency and high-quality in the clinical delivery of care
• Participate in company-wide quality improvement initiatives across all aspects of the organization
• Ensure care is provided in compliance with all state laws and regulations
• Detect, prevent and correct fraud, waste and abuse
• Other duties as assigned

JOB REQUIREMENTS:

• Ability to work designated schedule, reliable attendance
• Skilled business background
• Proficient leadership skills
• Knowledge of HEDIS and STAR ratings
• Knowledge of Medicare, Medicaid, I-SNP, Nursing Facility and Managed Care
• Proficient knowledge of Microsoft Office applications
• Punctuality, reliability
• Successful completion of required training
• Manage stress appropriately
• Handle multiple priorities effectively
• Independent discretion/decision making
• Make decisions under pressure • Position may require flexible hours, unscheduled overtime or occasional week-end work
• Unrestricted driver's license; clear driving record
• Some travel may be required

Required Computer Software/Equipment used:

• Standard office equipment
• Microsoft Suite applications
• SharePoint
• Visio
• Ability to learn HRIS and/or scheduling systems

REQUIRED QUALIFICATIONS:

• Education:

o Master's degree in nursing

• Experience:

o 3 to 5 years' experience in long-term care or with chronically ill patients

o 3-5 years of practice experience

o 1-3 years management experience in long-term care, home health or chronic condition management preferred

o Vast experience in leadership and business preferred

o Extensive knowledge and experience with Medicare, Medicaid, I-SNP, Nursing Facility and Managed Care

preferred

o HEDIS / STARs experience preferred

• License/Certification(s):

o APRN or PA license required

COMPANY COMPETENCIES:

• Respect- We treat people as they want to be treated, showing regard for their rights and privacy
• Integrity- We emphasize honesty, fairness, and doing the right thing even when no one is watching
• Teamwork- We work collaboratively to improve processes, resolve problems and reward results
• Excellence- We hold ourselves to the highest standards, aspiring to zero defects in every task
• Compassion- We respond to those who need help with sensitivity and a positive attitude
• Professionalism- We perform our duties with skill, good judgement and politeness

JOB COMPENTENCIES:

1. Analytical Thinking: Able to gather and analyze data and reach appropriate conclusion; solves problems in a timely manner.

Use logic and reasoning to identify changes in patients' conditions and determine the correct plan of action.

2. Customer and Personal Service: Possesses good interpersonal skills while dealing with emotional or difficult situations; responds promptly to customer's needs. Knowledge of principles and processes for providing personal services, including needs assessment; meeting quality standards.

3. Accountability: Accepts responsibility for own decisions, actions and results; able to maintain dependable behavior in times of crisis or complexity. Understands an error in action may affect the entire organization and lead to major cost and inconvenience with potential to jeopardize the organization's long-term performance.

4. Attendance: Is consistently at work and on time; ensures work responsibilities are covered; returns from lunch and breaks

appropriately; arrives at meetings on time; notifies supervisor of pending absences.

5. Communication: Speaks and writes clearly and persuasively; listens and receives clarification; interpersonal contacts with individuals within or outside of the organization may occasionally result in unexpected and immediate demands, requiring the restructure of priorities.

6. Ethical Behavior: Upholds organizational values and abides by state and federal regulations; maintains confidentiality of HIPAA information; treats others with respect.

7. Initiative: Seeks increased responsibility; sets self-improvement goals linked to the organizational goals.

8. Job and Industry Knowledge: Demonstrates knowledge of the position and industry; seeks additional information.

9. Productivity and Quality of Work: Maintains high level of performance while demonstrating commitment to accuracy and thoroughness.

10. Teamwork: Displays ease working with others; contributes ideas and skills to team; puts success of team above own interests.

Communicates with co-workers at all levels to adequately meet the needs of patients.

SCOPE AND LEVEL OF WORK:

• Complexity: Duties assigned are generally complex and may be of substantial intricacy. Work assignment is performed within an established framework under general instructions but requires simultaneous coordination of assigned functions or projects in various stages of completion.
• Decision Making: Exercises judgment and discretion, and is responsible for determining the time, place and sequence of the work performed.
• Communications: Contacts with the public or employees where explanatory or interpretive information is exchanged, defended, and gathered and discretion and judgment are required within the parameters of the job function.
• Supervision Received: Performs work with supervisory oversight. Under general supervision, the employee receives assignments and is expected to carry them through to completion with substantial independence. Work is reviewed for adherence to instructions, accuracy, completeness, and conformance to standard practice or precedent. Recurring work clearly covered by guidelines may or may not be reviewed.

SUPERVISORY RESPONSIBILITES:

• First line supervision and delegation of duties to all Providers (NPs/PAs) and RN Case Managers in direct clinical care

services

• Frontline oversight, planning, and delegation of onboarding activities of new employees within the designated region
• Responsible for provider relations issues below regional or corporate levels that would affect P&Ps
• Supervise support staff including scheduling and assigning work, reviewing performance, recommending salary increases,

promotions or discharges

• Occasionally needs manager's direction due to extraordinary circumstances

WORKING CONDITIONS:

• Audio-Visual: Good
• Hearing: Good
• Ability to lift up to 15 pounds
• Pathogens: Risk of exposure to bloodborne pathogens and other contagious illnesses
• Subject to standing, walking, sitting, bending, reaching, kneeling, pushing and pulling
• Work is typically performed in a standard office environment; well-lit; comfortable temperature-controlled
• Position may require flexible hours, unscheduled overtime or occasional week-end work
• Must be able to speak and write in English
• Travel may be required

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 may be made to enable individuals with disabilities to perform the

essential functions.

SAFETY EXPECTATIONS:

• Work safely and follow safety rules
• Report unsafe working conditions and behaviors
• Take reasonable and prudent actions to prevent others from engaging in unsafe practices

EQUAL OPPORTUNITY EMPLOYER

This Organization is an equal opportunity employer. We do not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. This Organization will make reasonable accommodations for qualified individuals with disabilities should a request for an

accommodation be made. A key part of this policy is to provide equal employment opportunity regarding all terms and conditions of employment and in all aspects of a person's relationship with the Organization including recruitment, hiring, promotions, upgrading positions, conditions of employment, compensation, training, benefits, transfers, discipline, and termination of employment.