NPST Clinical Operations Manager (86155)

We are hiring for a Clinical Operations Manager supporting the Laredo facilities and Upper and Lower Valley Regions!

The Clinical Operations Managers for Texas Independence Health Plan will be responsible for managing the ISNP program in the Texas market. The COM will directly manage and oversee the ISNP plan's staff of employed NPs and RNCCs delivering care on a day to day basis in Institutional Special Needs Plan to assure Provider-level care coordination, as outlined in the Texas Independence Health Plan (ISNP) Model of Care, for all ISNP Members. This is a regional based role that reports to the Director of Clinical Operations (DCO)

The COM will monitor that the NPs and RNCCs are in compliance with the ISNP MOC requirements and Plan Policies. The COM is expected to be available during customary working hours (approximately 8:00am - 5:00pm) to provide availability to NPs and RNCCs, with consideration for weekday/weekend on-call support duties

• Responsible for maintaining a high measure of professionalism in dress and actions that appropriately reflect the mission and policies of the organization and facilities with whom the NPs and RNCCs work and within which they work.
• Excellent communication skill and relationship management.
• Manage and oversee NPs and RNCCs on a day-to-day basis.
• Staff management; recruitment, training and competency development of clinical staff.
• Clinical program execution and delivery of metrics.
• Relationship management with internal and external clinical customers
• Maintain communication with facility leadership, and staff, through scheduled monthly meetings with DONs.
• Manage medical expense through utilization management, clinical delivery expenses/FTE management, quality metrics and accurate documentation and coding.
• Conduct regular agenda driven meetings with clinical staff (NPs and RNCCs) to address issues and concerns to communicate and cooperate with company specific philosophy.
• Oversee quality of care by NPs and the appropriate level of documentation and coding.
• Conduct chart audits, conduct routine audits on sample charts by NPs.
• Perform rotation for on-call Manager support weekdays/weekends and holidays.
• Ensure MOC training is delivered to NPs and RNCCs upon hire and annually thereafter
• Efficiently navigate and operate a laptop computer and software.
• Responsible for routine chart audits to identify risks, trigger events, contingency planning and advance illness planning compliance.
• Verify accuracy and timely documentation and coding.
• Communicate professionally in face to face conversations with NPs and RNCCs.
• Review post hospital POC, contingency, APC and documentation with NPs and prepare PAU review for bi-weekly presentations.
• Perform clinical rounds with NPs, scheduled and as needed.
• Maintain adequate Medical Malpractice Insurance (generally expected to be $1m/$3m).
• Perform all other duties congruent with The ISNP Plan as assigned.

Educational/Training Requirements

MSN, current Board Certification

Licensing Requirements

RN, APN/APRN

Experience Requirements

The NP is licensed as both a Registered Nurse and an Advanced Practice Registered Nurse in the state of Texas. A minimum of 1-2 years of SNF/ISNP MOC experience is required. The NP maintains an up to date Board Certification in his/her specialty. Proven record of collaborating and partnering effectively with physicians and facility leadership. The NP is responsible for maintaining a Texas Statutory Prescriptive Authority Agreement with attending Physicians and/or Medical Directors and for maintaining Texas Board of Nursing ongoing educational requirements for licensure and re- certification. The NP will comply with all State and Federal guidelines required to practice as a licensed Advanced Practice Registered Nurse, including maintaining an active RN and APRN license. The NP will maintain Professional Medical Malpractice Liability Insurance.