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Director of Clinical Services in Greenwich, CT at Pride Health

Date Posted: 11/23/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    Greenwich, CT
  • Experience:
    Not Specified
  • Date Posted:
    11/23/2018

Job Description

Director of Clinical Services

Responsible for Clinical Management (UM Coordination). 

Involved in the development, implementation, and monitoring of all patient care programs including Utilization Management.  

Lead the clinical activities of the utilization management team.

Directly supervise RN Care Managers and administrative staff.

Clinical peer reviews of UM decision making of Care Managers.

Interact with patients and providers associated with the active management of the patient’s care, when necessary or requested due to escalation, to ensure patient needs, treatment, and/or proper protocol is handled correctly.

Responsible for overall direction and evaluation of the clinical aspects of Care Management.

Prepares reports for and participates in monthly Utilization Management Committee meetings. Participates in reviews of all denials and assesses whether protocols and procedures as well as state mandates were followed in such a way as to assure good medical care was provided.

May assist sales team with clinical aspect of client meetings and calls

Acts as subject-matter expert for best practices, evidence-based guidelines, and current trends in fertility management.

Collaborates closely with VP, Clinical Services & QA to ensure all initiatives are aligned to strategic goals and are integrated throughout the company.

Participates in process improvement and development to make recommendations within the scope of accountability.

Attends continuing education programs.

Interview, hire, and train employees; planning, assigning, and directing work.

MINIMUM QUALIFICATIONS

Minimum one-year experience in Utilization Management/Review preferred.

Graduate of an accredited school of nursing with a minimum of an Associates or Bachelor’s degree.  Current nursing license.

Minimum of two years’ experience managing staff preferred.

Minimum of five years’ infertility experience preferred.