Maximus’s Clinical Services Division performs a wide array of clinical assessment services for individuals with physical and/or mental disabilities seeking Medicaid-funded services and supports. The incumbent provides oversight of a regional network of field clinical assessors. The RN Regional Supervisor is responsible for quality assurance of clinical assessors and monitoring key quality and operational processes to ensure fidelity to assessment protocol and consistent assessment reliability and validity among and across assessors.
1. Manages of the quality of regional field clinical assessors, including inter-rater reliability (IRR) activity, monitoring quality trends among assessors, and other quality activities as appropriate.
2. Ensures assessor compliance with assessment protocols, performance standards, and meeting all customer expectations for quality. Monitors quality processes and informs Program Manager about quality performance issues.
3. Documents quality issues and performance measures for management review, and provides information to assist in the feedback and formal education process of employees. Develop processes to build operational policies, procedures, and/or user guides for the project.
4. Address exceptional issues related to quality, service and compliance of the project. Analyzes operational processes, including reviewing, creating, and improving policies, procedures, systems, forms, and reports. Analyzes existing forms and methods to promote effective operations through standardization, improvement, simplification, discontinuance or other methods.
5. Responsible for working with the Program Manager to develop strategies to prevent drift and maintain adherence to quality expectations to ensure effective program operations.
6. Performs other duties, as necessary or assigned by the Program Manager.
Knowledge, Skills & Abilities
• Ability to lead and drive continuous quality improvement
• Ability to work effectively manage a remote team
• Outstanding work ethic, integrity, and value system
• Excellent clinical process skills
• Ability to perform all job duties in compliance with Person First standards, HIPAA guidelines, and company confidentiality policies
• Ability to multitask effectively while performing job duties, including ability to prioritize tasks and ensuring all voice mail and email messages are returned expeditiously
• Excellent organizational skills
• Excellent negotiation and interpersonal skills, including ability to use effective diplomacy in dealing with senior business leaders and other business parties
• Ability to work independently with minimal day-to-day supervision
• Ability to interact professionally and collegially with referral sources (hospital & nursing home staff, physicians, social service workers, etc.), state contract officers, and coworkers
• Advanced skill with word processing, spreadsheet, presentation, and publishing software (Microsoft Word, Excel, PowerPoint, Publisher, and Visio strongly preferred)
The job requires a Registered Nurse licensed in North Carolina; specialty in geriatrics or adult home health is preferred.
The job requires a at least three (3) years of experience in clinical medical settings, hospital and home health experience, including experience managing and/or collaborating with clinical professionals.
Essential Duties and Responsibilities:
- Supervise a minimum of 6 employees through cultivation of a high performance team-oriented environment that is consistent with the culture and values of Ascend.
- Coordinate all required tasks related to employee schedule changes and time- off.
- Interview and make recommendations for selection of new employees.
- Prepare 30- 45 day orientation plans for new hires.
- Conduct on-the-job training for new employees.
- Coach and counsel employees for success.
- Conduct regularly scheduled 1:1 meetings with direct reports.
- Assist the manager with enhancing contract performance through monitoring and ensuring compliance with contract requirements and Policies & Procedures, communicating all recommendations and actions with the manager.
- Facilitate cross-department collaboration through day-to-day interactions and focused efforts.
- Assist the manager with maintaining a positive customer relationship through ensuring effective communication with customers and employees, assisting with the resolution of customer/provider complaints, and properly documenting relevant customer/provider complaint information.
- Assist the manager with continual process improvement initiatives by monitoring assigned workflow and processes and providing feedback to the manager about ways to refine and optimize them.
- Work collaboratively and effectively with IT to ensure that product and service applications and technologies are optimized for contract compliance, productivity, and quality performance.
- Ensure that all employees and contractors understand and comply with HIPAA and privacy laws while utilizing all Ascend applications and related software/technology.
- Complete quality reviews on Clinical Reviewer, Level I employees, as identified by manager, to ensure Division benchmarks are met.
- Conduct telephonic and document based utilization review that adheres to state directed clinical criteria for determining medical need.
- Associate degree or equivalent combination of education, technical training or work experience considered in lieu of degree.
- Minimum of two (2) years of related experience.
- Ensure compliance with company Wage & Hour policy, including ensuring non-exempt employees get the rest & meal breaks.
- Comply with all company required policies, procedures and processes including but not limited to required training.
- Provides immediate supervision to a unit or group of employees, assigning tasks, checking work at frequent intervals, and maintaining schedules.
- A portion of time is normally spent performing individual tasks related to the unit or sub unit.
- Generally supervises semi-skilled employees or a few individual professional contributors.
- Works on issues of limited scope.
- Follows established practices and procedures in analyzing situations or data from which answers can be readily obtained.
- Monitors daily operations of a unit or sub-unit.
- Requires full knowledge of own area of functional responsibility.
- Frequently interacts with subordinate employees and functional peer groups.
- Interaction normally requires the ability to gain cooperation of others, conducting presentations concerning specific projects or schedules.
- Receives predetermined work assignments that are subject to a moderate level of control and review.
- Directs subordinates to complete assignments using established guidelines, procedures and policies.
- Develop work schedules and assign duties to subordinates to ensure efficiency.
- Evaluate subordinates' job performance and recommend appropriate personnel action.
- Discuss job performance concerns with subordinates to identify causes and issues and works closely with the Human Capital department on resolving problems.
- Identify training needs and development opportunities for subordinates.