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Clinical Quality and Training Manager

Location: Portland, OR
Job Code: 309
# of Openings: 1

Description

Clinical Quality and Training Manager – Utilization Review

AllMed Healthcare Management’s mission is to improve the quality and integrity of healthcare by providing independent medical review services that help payers and providers deliver better health outcomes. We partner with hundreds of leading health insurance and hospital organizations and have maintained consistent growth, through our commitment to the highest quality, client satisfaction, and technology innovation.  Services are delivered through PeerPoint®, AllMed’s state-of-the-art medical review portal.  We have recently undergone a Lean transformation in our Clinical Operations, with the goal of driving continuous improvement in our performance.

 

We are seeking a Clinical Quality and Training Manager with Lean experience to join our clinical operations leadership team as we continue to build our profile as a national leader in the industry.  MedReview is AllMed’s innovative solution for health plans and payer organizations, which allows them to partner with AllMed for specialist reviews of pre-authorization and appeals requests.  AllMed has grown steadily over the past several years, as health plans seek to outsource more of their routine physician review processes to companies like AllMed.

 

In this position, you will have overall responsibility to plan, develop, implement and maintain the Clinical Operations Quality and Training Program; collaborate with the Clinical Operations Production Manager to manage daily clinical case review production; act as a mentor and leader to clinical team in the professional practice of nursing as it applies to utilization management and independent review; ensure operational excellence, process improvement, and customer satisfaction through application of Lean management principles. The Clinical Quality and Training Manager provides leadership to clinical staff to ensure achievement of key performance metric targets and delivery of high-quality, on-time reviews to our clients.

 

Your responsibilities will include:

  • Managing and directing clinician team to ensure high-quality, accurate and on-time reviews
  • Managing Clinical Operations quality and training program to effectively and efficiently onboard new hires and ensure ongoing upskilling of existing staff
  • Managing development and maintenance of standard work documents, job aids, templates, and clinical content to support high-quality, consistent, and efficient review of cases
  • Monitoring, analyzing, tracking, reporting and acting on key performance metrics to achieve quality targets
  • Managing team performance, leading by example, and mentoring team members to increase efficiency, quality and capability
  • Participating in recruitment and hiring activities to identify and onboard high-performing clinicians to increase capacity
  • Collaborating effectively with the Clinical Operations Production Manager to ensure appropriate workload balance and achievement of case flow targets
  • Collaborating effectively with the Medical Director and Peer Value Streams team to provide feedback and support to peer reviewers to ensure high-quality reviews
  • Collaborating with Sales to support and respond to client needs and ensure smooth implementation process for new clients
  • Collaborating with IT to support development and enhancement of automation and tools to increase efficiency and quality of reviews, including support of end user acceptance testing
  • Participating in cross functional teams and Lean continuous improvement activities including root cause identification and problem solving to improve processes
  • Other duties as directed by Senior Clinical Operations leadership

Qualifications include:

  • Bachelor’s degree in Nursing with current unrestricted Registered Nurse license required
  • At least 3 years of leadership/management experience, preferably within a production-oriented utilization review, case management or clinical operations setting; Master’s degree in Nursing, Education, Administration or similar preferred.
  • Clinical nursing background
  • Experience in utilization review/management, case management, appeals management or related area required
  • Experience developing and managing training and quality programs
  • Experience and/or formal training in Lean preferred 
  • Strong analytical skills, using Excel and other tools to develop/model production metrics and trends  
  • Demonstrated ability to effectively respond with urgency to issues impacting production and quality
  • Strong computer skills, including MS Office and general web applications 
  • Experience developing operational standards, including standard work and job aids 
  • A passion for empowering and developing employees 
  • Ability to effectively prioritize and manage projects
  • Ability to effectively manage change
  • Strong multi-tasking, decision making and advanced problem-solving skills 
  • Outstanding interpersonal, teamwork and verbal communication skills
  • Ability to type at least 35 words per minute 

 

AllMed offers competitive compensation based on experience, comprehensive benefits and a generous vacation package.

AllMed provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.





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(800) 400-9916
111 SW Fifth Ave., Suite 1400, Portland, OR 97204
AllMed Healthcare Management, Inc. All rights reserved.

AllMed is an independent review organization with a panel of 400 physician peer reviewers who are licensed, board-certified and in active practice, covering more than 80 ABMS specialties and sub-specialties. AllMed offers medical, copy-editing and customer resources that enable clients to improve quality of care and patient safety.