Nature and Scope
The Clinical Service Manager (CSM) is a key position in the organization with both clinical and managerial responsibilities. The CSM will implement Medicare-compliant policies and procedures and oversee a full or part-time contracted NP workforce. The successful individual will ensure client expectations are met for clinical outcomes, quality metrics and patient and provider satisfaction. The success of the CSM will be a reflection of the success of the team that he or she manages. This position provides an opportunity to be part of a fast-growing digital health startup company designed to impact the health of populations effectively and efficiently. Be part of company destined to transform how chronic care is delivered to large populations!
The company is seeking an experienced nurse practitioner who brings clinical expertise in chronic conditions and a passion for healthcare transformation. The successful candidate is a team player, a compassionate communicator and passionate about population health, social determinants of health and providing access to care for the underserved. You will review daily medication adherence trends, monitor data against clinical protocols, and develop a treatment plan. You will also manage the care coordination team in support of primary care practices. In this role you will collaborate with pharmacists, physicians and other care coordinators to deliver remote patient monitoring (RPM), transitional (TCM) and chronic care management (CCM) services serving large populations of patients.
The CSM will oversee a care team of contracted NPs, registered nurses and care coordinators. Using the DayaMed platform, the CSM will implement a medication adherence and remote patient monitoring program that coordinates care with patients, caregivers and providers. The CSM will be responsible for engaging and training a remote team of professionals in the DayaMed values and expectations.
- Develop and support a Medication adherence remote patient monitoring (RPM) program:
- Provide evaluation and treatment services and establish a patient care plan;
- Assure RPM and CCM compliance and clinical documentation with Medicare and Medicaid rules and regulations;
- Provide robust training to clinical team on: use of the CareCloud EMR, the DayaMed application DayaMed Values, and clinical support;
- Train case managers in workflows, patient identification, eligibility criteria and discharge criteria; practice virtual visits, voice calls and text messaging. Customize care plans.
- Analyze and evaluate clinical monitoring and the day-to-day workflow of the clinical staff and broader clinical team.
- Establish patient discharge plans from virtual health and RPM based on client requirements or model of care and health outcomes.
- Record staffs’ performance based on outcomes and feedback; document and discuss staff performance against company values and behaviors annually;
- Create a high-functioning collaborative team and conduct performance reviews based on company values and expectations.
- Assure that patient care is provided in accordance with clinical guidelines and professional standards; i.e., educate and evaluate the clinical team on individual ability to:
- Assess patients’ physical and mental wellness needs, preferences and abilities and develop plans to improve;
- Work with patients, caregivers and health care professionals to put care plans in place;
- Actively listen to patients’ concerns and provide counseling or intervention as required;
- Record patients’ progress, charting referrals and scheduling referrals back to primary care provider as needed;
- Evaluate patients’ progress and periodically make adjustments as needed.
- Seek treatments or referrals that balance clinical and financial concerns with the family’s needs and the patient’s quality of life.
- Demonstrated leadership in managing subordinates.
- Demonstrated capability in resolving escalated issues arising from operations and requiring coordination with other professionals.
- Contribute to the development and improvement of clinical care protocols, policies and procedures.
- Provide input to strategic decisions that affect the functional area of responsibility.
- Foster an environment of continuous iteration and support by:
- Sharing weekly patient stories and improvement areas
- Ensure that program has continuous improvement and momentum.
- Master’s Degree in nursing from an accredited university in Adult or Family Nurse Practitioner program.
- Active, unrestricted advanced practice registered nurse license
- Accredited National Certification as a Nurse Practitioner
- Minimum of three to five years full time equivalent experience in direct clinical care
- Minimum of two (2) years full time equivalent experience in a supervisory role of clinical staff
- Working knowledge of Medicare, Medicaid and commercial carrier reimbursement policies
- Working knowledge of electronic health record systems
- Ability to analyze and interpret clinical data
- Working knowledge of URAC and case management strategies
- Excellent empathetic, active listening and collaboration skills.
- Excellent organizational skills
- Clinical expertise in primary or acute care, medication and chronic care management
- Demonstrated technical aptitude and project management skills
- Experience leading clinical operations in care management
- Healthcare insurance, paid PTO, continuing education