The Clinical Director oversees quality functions in Maximus’s Clinical Services Division, which 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 management and execution of key quality, technical, and operational processes to support program and technical operations. This role is based in Raleigh, NC; however, due to precautions related to COVID-19, this position may be temporarily remote.
1. Directs clinical operations of the company, ensuring compliance with standards. Holds formal and informal meetings and discussions with employees to offer clinical support and ensure clinical compliance in all areas of operations. Ensures clinical standards are incorporated into all project plans. Informs the Project Director about new and ongoing clinical issues. Communicates clinical updates throughout the company.
2. Directs the management of the company Quality Improvement Plan (QIP) with the Quality Improvement Manager, ensuring compliance with standards and meeting customer expectations. Develops and monitors QIP processes and informs Project Direction about quality performance issues.
3. Leads investigations of all clinical concerns, including formal complaints and quality of care concerns, through careful analysis of documentation and discussions with associated employees, customers, and/or stakeholders. Ensures complaints investigation and quality of care concern processes are followed and recommends course(s) of action to Project Director.
4. Responsible for the delivery of a wide range of complete strategic program and/or business process analytics for the project. Analyzes trends and creates solutions to ensure that customer service needs are met, and the program remains in compliance. Collects reportable data and completes any reporting needs for the project.
5. Directs the management of the quality of the program with the Project Director, ensuring compliance with standards and meeting customer expectations. Develops and monitors quality processes and informs Program Director about quality performance issues.
6. Translates reportable data into information, interprets data, and understands the implications of data to the business. Provides recommendations to management, create and implements strategies to ensure that productivity goals are met while containing costs for the program.
7. Documents program 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.
8. 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.
9. Responsible for working with the IT Vendor to develop improved systems to ensure effective program operations.
10. Performs other duties, as necessary or assigned by the Project Director.
• Accountable for meeting all established quality and data analysis goals for the project
Knowledge, Skills & Abilities
• Ability to lead and drive continuous quality improvement
• Ability to work effectively in a “hands-on” management role
• 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 analyze large and varied sets of data and draw meaningful conclusions
• 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)
Eligible candidates must have a Bachelor’s degree in a health and human services discipline and be a Registered Nurse or Licensed Clinical Social Worker, licensed in North Carolina. Doctorate of Nursing Practice specializing in geriatrics or adult home health is preferred.
The job requires at least five (5) years of experience working in a clinical medical capacity, knowledge of hospital and home health care, including experience managing and/or collaborating with physicians and statistical experience associated with sampling strategies, trending and analysis, and implementation of feedback strategies. Professional training and/or certification in a formal quality program (e.g. Six Sigma, Baldrige, CQM) preferred. Knowledge of Medicaid programs strongly preferred.
Essential Duties and Responsibilities:
- Process a variety of assessments and reviews, providing psychiatric expertise.
- Facilitate and conduct regular physician inter-rater reliability reviews, including presentation of findings and peer discussions, as appropriate.
- Ensure that final outcomes meet psychiatric accuracy and quality standards of state contracts, client, and project.
- Participate in the development, approval, and review of all policies, procedures, and protocols that govern psychiatric care.
- Participate in the recruiting, evaluating, and hiring of all psychiatric staff, including employees, independent contractors (assessors), and QIO panel representatives. Participate on the Credentialing Review Committee to ensure all assessors meet the requirements of the project and each state contract.
- Act as a psychiatric physician advisor, assist with related staff development and in-service training for all psychiatric needs at Ascend and offering peer-to-peer consultation for complex case conferences, quality of care concerns, reconsideration reviews, and others.
- Provide psychiatric direction during Quality Management Committee meetings.
- Utilize a variety of methods (reading/reviewing published articles, business networking, group discussions, etc.) on a regular basis to stay abreast of evidence-based psychiatric practices and outcomes that are relevant to project's work.
- Perform other duties, as necessary or assigned by the Clinical Director.
- Direct and control the activities of a broad functional area through several department managers within the company.
- Has overall control of planning, staffing, budgeting, managing expense priorities, and recommending and implementing changes to methods.
- Work on complex issues where analysis of situations or data requires an in-depth knowledge of the company.
- Participate in corporate development of methods, techniques and evaluation criteria for projects, programs, and people.
- Ensure budgets and schedules meet corporate requirements.
- Regularly interact with executives and/or major customers.
- Interactions frequently involve special skills, such as negotiating with customers or management or attempting to influence senior level leaders regarding matters of significance to the organization.
- Report to Senior Director or VP level.