Clinical Program Manager (KidWise)

Job Summary

The Clinical Program Manager (KidWise) is responsible for managing coordination for all operational and clinical activities for the Pediatric Concurrent Care program, including, but not limited to, overseeing coordination of verbal and written communication between patients, families, physicians/providers, community partners and the interdisciplinary team, processing of incoming referrals, obtaining authorizations, supervising documentation in EMR and management of quality data. Duties also include oversight of departmental budget, billing process & reimbursement, managing and supporting staff (including scheduling as required), representation of the programs in the community, internally, and coordinating/organizing internal and external meetings.

Essential Responsibilities

Manager Duties:

• Ensure delivery of high-quality, cost-effective care to patients/families, through coordination of daily clinical operations in the pediatric concurrent care program
• Responsible for the direction and management of the interdisciplinary team.
• Coordinates and supports interdisciplinary staff to promote optimal team functioning.
• Provides clinical direction and oversight of acuity ensuring optimal clinical outcomes and regulatory compliance. Names and monitors high acuity level situations, report follow up and tracks trends.
• Assists Clinical Leadership team in review and maintaining policies/procedures related to Concurrent Care.
• Facilitates IDT meetings and continued eligibility review to promote patient centered care planning in an effective and efficient manner.
• Monitors and ensures appropriate, individualized plan of care interventions and follows up to identified issues.
• Assures timely, accurate and compliant documentation in medical record.
• Manages/reports up appropriate clinical staff and system issues, concerns and suggestions to Chief Clinical Officer, and/or Chief Medical Officer as appropriate.
• Acts as a professional liaison for HSCC to build community partnerships across various care settings, programs, providers and insurances.
• Program oversight to steward financial sustainability and relevance of programs.
• Staffing and budget oversight.
• Lead process improvement projects for department.
• Partner with QAPI program to monitor quality of program and clinical efficiency
• Coordination with Development & Philanthropy, to support grant proposals and metrics required.
• Coordinates/organizes meetings internally and with community partners
• Oversight of referral and authorization process.
• Community / Inter-departmental Program Representative

Other Duties:

• AOC: Serves as Administrator On Call as assigned for Agency
• Support Programs by providing Patient Visits in collaboration with the care team, as needed, to maintain the quality and service goals of the program.
• Support program by assisting in receiving, documenting and triaging incoming calls, promptly alerting the interdisciplinary team of any issues that require immediate action
• Communicates, verbally and in written form, regarding program and patient care needs between the interdisciplinary team and all outside community partners (physician's offices, pharmacies, medical equipment suppliers, community services agencies, RCFEs, SNFs, etc.)
• Maintains staff schedules to ensure adequate coverage during program hours.
• Participates in the leadership, facilitation and documentation of department meetings as requested
• Manages/reports up appropriate clinical issues to Chief Clinical Officer/Medical Director. Maintains collaborative partnership.
• Responds in timely manner to Unusual Occurrence, Patient Feedback, Incident Reports and Complaints.

Requirements

Education/Experience

• Previous Pediatric experience
• Supervisory and managerial experience required
• Current RN or Family Nurse Practitioner (FNP) license for California
• A minimum two years RN experience or one year Nurse Practitioner experience preferred
• Current DEA license (if NP)
• Graduate from an accredited school of Nursing.
• Master degree in appropriate field of nursing preferred.
• Familiarity with Medicare, MediCal, and private insurances
• Knowledge of medications, medical terminology, sterile techniques and medical system processes

Skills Required

• Ability to relate to people of diverse cultures and ethnic backgrounds
• A high degree of initiative, motivation and energy
• Ability to support a team through process changes, setting structure and frameworks for a scalable model program.
• The ability to work independently, manage multiple tasks simultaneously and consistently follow through
• Excellent communication, interpersonal and organizational skills
• Ability to develop and maintain strong relationships and work as part of an interdisciplinary team
• Excellent collaborative and problem solving skills
• Advanced computer literacy including word processing, spreadsheet and electronic medical records data entry

Preferred Qualifications

• Credentialed through Medicare with ability to bill for services
• Current knowledge of applicable Palliative Care billing codes and practices

Certifications, Licenses, Registrations

• Pass OIG/GSA review and all required background checks

Physical Demands

• Strength to lift and carry materials weighing up to 15 pounds
• Vision to read printed materials and a computer screen
• Hearing and speech to communicate in person and over the telephone

Work Environment/Environmental Condition

• Must possess mobility to work in a standard office setting and to use standard office equipment, including a computer