Clinical Project Manager RN

The Clinical Project Manager works directly with the Campus Medical Director towards the goal of enhancing the overall health of our members. They are responsible for participating in daily patient care rounds as well as all interdisciplinary team meetings and will assist in implementing care plans. They will review discharge plans for thoroughness and completion, working with internal teams to ensure all referrals have been placed.

The clinical Project Manager links the Medical Director, inpatient case manager, inpatient coordinator, behavioral health, patient advocacy, social work, member services, and other stakeholders involved in the inpatient care of our members. The Clinical Project Manager will communicate frequently with contracted physicians to discuss metrics and strategies to improve health outcomes. They will analyze utilization data to assess for trends and plan interventions accordingly.

They will evaluate actions continually, adjusting to meet the needs and goals of the company. The successful Clinical Project Manager will bring internal teams and contracted physicians together to provide efficient, cost-effective, patient-centered care to our members. The Regional Medical Director will be responsible for annual reviews and employment oversight.

Education and / or Experience:

• Clinical Experience necessary (RN, NP, PA, pharmacist, etc.)
• 3+ years of Project Management Experience in Healthcare/Managed Care preferred
• Minimum 2 years of case management experience as a nurse preferred
• High level knowledge of Concurrent Review/Case Management processes and principles
• Prior experience in MSO environment preferred.
• Ability to work with all levels of management.
• Must have excellent communications skills both verbally and written.
• Must have excellent organizational skills.
• Prior experience with project development and implementation preferred.
• Required to travel to meet with contracted physicians
• Requires current CA driver’s license and car insurance

Essential Duties and Responsibilities include the following:

• Coordinates activities from the various stakeholders (the patient, family members and friends, hospitalists, inpatient case management, PCP, visiting physicians and nurses and others) to create a seamless patient experience of transition of care.
• Develops, monitors, and analyzes reports and identifies trends to develop programs and processes that improve program outcomes.
• Identifies and assists in the development of Concurrent Review policies and procedures and assists the Medical Director to oversee compliance and consistency of the program that meets RMG and regulatory standards.
• Assists with the development and implementation of training plans for new and existing staff.
• Acts as a resource for clinical staff for case review and discharge planning.
• Develops and coordinates strategies across the continuum of care for ensuring the delivery of care in the most cost effective setting.
• Collaborates with management to analyze data and implement programs that will improve patient outcomes.
• Develops annual department goals and objectives focused on improving patient outcomes and department efficiency.
• Acts as a role model for staff appropriate case manager and customer service behaviors.
• Works collaboratively with the entire Medical Management team to ensure compliance with regulatory and health plan requirements.
• Develop working relationships with hospital case management departments to facilitate timely reviews.
• Works closely with other departments (claims, finance, high risk, CM, TOC) as needed.
• Assumes other responsibilities as assigned.
• Anticipate our customer needs:
  Understand the wants and needs of customers, listen for cues and identify how to respond and what level of intervention they need.
• Survey the customer’s environment and take appropriate action.
• Refrains from discussing personal business in front of the customer or speak a foreign language different from the customer’s language.
• Greets patients, family members, and visitors, physicians in a positive manner by introducing self, speaking clearly and with confidence.
• Returns phone calls to customers and follows up with requests.
• Keeps patient/family…