Reports to: CMO

Collaborates with: CEO, AMS Management Team, Practice Managers

JOB SUMMARY: 

Affinity Medical Solutions, an MSO supporting Affinity Medical Group, is seeking a dynamic clinical operations director to lead strategic clinical operations including Utilization Management, Case Management, Referral Services and Disease Management and to ensure high quality, cost-effective utilization of services across the continuum of care.​ The position is responsible for major change efforts within the scope of clinical management.​  .

PRIMARY RESPONSIBILITIES:

1.       Under the supervision and direction of the Chief Medical Officer, the Director will lead and develop a medical management team and will direct the utilization management and medical management delegated programs.​ 

2.       The director will build relationships with key staff of the contracted health plans, key community and business partners and will work closely with senior management and medical directorate to ensure integration of clinical operations strategies.​

3.       Supervise of the Medical Management staff

4.       Oversee referral authorization activities and referral authorization staff

5.       Supervise all activities related to the authorization of eligible services

6.       Oversee Authorization Review Committee meetings

7.       Support the notification process for providers and members to ensure compliance and efficiency

8.       Supervise the management of in-patient activities/processes

9.        Manage all activities related to the Quality Improvement process

10.    Clinical quality monitoring and improvement activities related to preventive health services and chronic illness pertinent to the long-term care population

11.    Support activities related to the Appeals and Grievances processes to ensure compliance with state, federal and company standards and regulations

12.    Other duties as assigned.

ESSENTIAL REQUIREMENTS

1.       The position requires a Registered Nurse with five years progressive management experience of quality improvement, disease management, and case management and utilization management programs.​ 

2.       A bachelor’s degree is required, a masters is preferred.​

3.       Strong leadership and management skills including demonstrated ability to mentor and develop staff are essential.​ 

4.       Position requires effective analytical, systems design, and program development skills as well as significant familiarity with clinical data systems

5.       Demonstrates low tolerance for mediocrity and exhibits conscientiousness and high sense of responsibility.  Works well under deadlines and ensures timely completion.

6.       Current California RN license

7.       Knowledge of long-term care, community resources and cost-effective alternatives regarding patient care delivery systems

8.       -Knowledge of CPT, ICD-9 and HCPC codes.

9.       Demonstrates strong organizational skills.  Self-starter with a need for minimal intervention or supervision.  Good ability to clarify directions when needed to continue tasks.

10.    Ability to prioritize and stay focused on assigned priorities.  Is comfortable operating in a complex matrix environment with multiple, competing or frequently changing priorities.

11.    Presents a polished, professional demeanor.

12.    Collaborates well with a variety of personality types and posses strong written and verbal communication skills.  Comfortable working with remote parties.

13.    Enjoys the selfless comradeship, challenge, and hustle associated with a growing, entrepreneurial company.

WORKING CONDITIONS

We are proud to offer a cheerful and supportive work environment.​  

Hours are primarily limited to business hours (8 AM – 5 PM, Monday through Friday), although occasionally may require additional hours to meet deadlines or attend functions.  The role is based out of the AMS offices located in Pinole, CA.