The Manager of Clinical-Quality will report to the Director of Operations and Strategy – Primary Care, and work collaboratively with the Manager of Operations and the Supervisor of Operations to lead and oversee all aspects of clinical operations to support the Health@Home program clinical model of care and other programs for high-risk members. He/she will be responsible for developing and operationalizing new clinical initiatives for targeted populations, insuring that all relevant regulatory and contractual requirements are met. This position will be responsible to identify, implement and manage clinical initiatives and pilots or the practice, engaging other internal and external partners as appropriate. He/she will have responsibility to establish relationships with primary care providers and facilitate opportunities for integration and collaboration. This position will serve as internal clinical consultant and subject matter expert with various departments such as Utilization Management, Case Management, Provider Network Management and Evaluation and Improvement to facilitate collaboration and process improvement opportunities that support effective clinical, quality and financial goals. He / she assumes accountability for timely and accurate identification, resolution and communication of issues related to clinical operations.
Job Specific Competencies:
In the role of business lead for assigned FDR; incumbent is responsible to complete comprehensive oversight and monitoring of their vendor that incorporates the following elements: efficient and effective operations; compliance with laws, regulations, policies, procedures; and other company performance issues designed to reduce risk and add value to the company
Neighborhood is an Affirmative Action and Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, genetic information, age, disability, veteran status or any other legally protected basis.
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