This role reports to the Director of Clinical Services and is responsible for the care coordination of the clinical population and Clinical Case Managers. Responsible for admissions and recertification assessments, including supporting documentation, as assigned. Ensures compliance with MGA, State, Federal, and policies of accrediting agencies. Responsible for maintaining compliance with all reimbursement guidelines. Participates in program development and implementation.Duties and Responsibilities Under the direction of the Director of Clinical Services - plans, organizes, and manages the provision of patient care and Clinical Case Managers, assuring that all patient needs are continually assessed.Acts as a first line manager for designated staff and assures coordination of new referrals and patient care including overseeing the development, implementation, and updates of the individualized plan of care.Day to day management of provider issues and care delivery.Contributes to improving quality and consistency of patient care & experience.Evaluates quality of care, patient satisfaction, compliance, and oversees both patient and personnel assignments.Facilitates Care Coordination Meetings and provides leadership in problem solving and gives professional advice from a clinical perspective.Reviews, implements and interprets clinical policies and procedures as directed by DOCS.Serves as a clinical lead at relevant clinical and departmental meetings.Enforces and demonstrates compliance with all State and Federal regulations.Communication with case managers (State funded programs, Medicaid, and third party payors), clinical updates, and ensuring continuing authorizations and re-verification of eligibility.Compliance and participation in the continuing quality improvement and utilization review of organizational services.Supports and executes the mission, ethics, and goals of the company effectively.Represents themselves in a positive and professional manner in the company and community.Adheres to dress code with a clean and neat professional appearance. Reports as scheduled in order to complete work within designated time.Adheres to all company policies and procedures outlined in the Employee Handbook, Employee Agreement, or communicated from Human Resources. May be required to maintain a patient caseload.Aid in terminations, coaching, education and counseling of field staff.Assist in the management of complaint intakes, track and follow-up.Participates in QAPI/PAC as appropriateOther duties as assignedClinical Manager Oversight Creates patient and personnel assignmentsCoordinates patient careCoordinates referralsEnsures that patient needs are continually assessedEnsures the development, implementation, and updates of the individualized plan of care
