PleasantonRecruiter Since 2001
the smart solution for Pleasanton jobs

Clinical Program Manager

Company: Albertsons Companies
Location: Pleasanton
Posted on: June 3, 2021

Job Description:

Clinical Program Manager

Join an integrated multidisciplinary team to impact the health and wellbeing of employees in this dynamic Clinical Program Manager role.

The Albertsons Companies with over 300,000 employees nationwide, which includes the well-known banners of Albertsons, Safeway, Vons, Pavilions, Randalls, Tom Thumb, CARRS and Jewel Osco has an opening for a Clinical Program Manager in the Corporate Risk Management Department. Base location of the position can be flexible, prefer: Phoenix, Boise, or Pleasanton, CA.

POSITION PURPOSE:

The Clinical Program Manager oversees and provides guidance on medical management programs and execution across multiple jurisdictions to ensure consistency across occupational health programs and claim offices in accordance with statutory rules, regulations, and in accordance with Albertsons Companies protocols, best practices, and business needs. Primary Responsibilities will be to manage performance improvement opportunities within General Liability and Workers' Compensation programs nationally. Ensure Third Party Claims Administrator Program compliance in accordance with client service instructions, best practices and jurisdictional laws and regulations. Develop and oversee practice protocols, benchmarking best practices consistent with multiple program needs. Analyze operational structures including staffing models, review company and divisional metrics to implement goals, programs, and processes to enhance operational efficiencies. Implement a quality control and performance improvement plan whereby it will assure self-administered claims, TPA general liability and workers' comp claims conform to all contractual provisions. This position involves extensive interface with other disciplines and departments including Corporate Risk Management VP's, Directors and Managers, Safety and Loss Control, Human Resources, Legal, Labor Relations, Division President, VP Finance on all matters related to General Liability and Workers' Compensation. The position serves as a key member of the risk management performance improvement team "PIT".

KEY ACCOUNTABILITIES:

  • Oversee the execution of Albertsons Companies best practices with clinical staff including medical case management nurses, utilization review and triage clerical personnel embedded in the TPA claim operations and/or vendor/contract clinical resources. Review and ensure execution of the program objectives, staff cases with claims, legal, or the medical director, and provide medical expertise to HR, claims, legal, and other personnel as needed; ensure medical case management assignments are based on clearly defined referral criteria; Maintain quality of medical recommendations and rationale using best practice references such as standardized disability duration guidelines, ACOEM, or other evidence-based medical management guidelines.
  • Provide oversight governance of managed care programs to ensure quality and effective use of clinical resources and compliance with program policies through ongoing evaluation of metrics and outcomes including UR, TCM, Delayed Recovery, and PBN/Pharmacy programs, bill review and other clinical programs needed to meet business needs. Ensure appropriate utilization of resources; Conduct ongoing program quality assurance reviews, operational assessment audits to ensure compliance and execution of program objectives. Effectively collaborate with partners to maximize outcomes. Analyze and interpret results of General Liability and Workers' Compensation program loss data to identify successes and/or trends and patterns related to adverse loss development.
  • Provide oversight and medical expertise on employee health, claims, medical and legal issues for risk management, claims, legal or HR personnel bring for consideration.
  • Participate in designing and presenting initial and ongoing training and orientation for staff, delegating other staff to participate in presenting their areas of expertise.
  • Review and develop medical management policies and procedures to ensure optimal outcomes and proactive cost-effective utilization of clinical resources.

KNOWLEDGE AND EXPERIENCE:

Education Level:

  • BSN strongly preferred, or ADN with 10+ years applicable work experience; MSN, MPH, or equivalent degree preferred.
  • Unencumbered licensed registered nurse in the state of practice and, as required, registered in jurisdictions in which UR/UM certification is required.
  • Certification in one of the following: CCM, COHN, COHN-S, CPDM, CRRN or equivalent.

Experience Level:

Minimum of ten (10) years of experience managing occupational health or workers' compensation programs, managing clinical staff and delivery of medical management programs.

Skills and Experiences:

  • Exceptional knowledge and experience in workers' compensation claims, medical and disability case management statutes, and jurisdictional differences.
  • Knowledgeable in utilization review/utilization management regulatory requirements, practices, and procedures across multiple jurisdictions.
  • Knowledge of related employment benefits (ADA, FMLA, state disability legislation, LTD, SDI, group health benefits) and how they interact with workers' compensation benefits.
  • Knowledgeable in occupational health/ employee health practices, including Evidenced Based Medicine (EBM) practices for managing occupational and non-occupational health programs.
  • Experience managing TPA managed care programs.
  • Manage and support multiple projects in a fast-paced environment.
  • Effectively collaborate with internal and external customers and claims team partners to maximize outcomes.
  • Proven ability to work with multidisciplinary teams.
  • Proficient in various electronic record-keeping systems, Salesforce, and Microsoft Office software.
  • Successful experience in conflict management and negotiations.
  • Analytic and problem-solving skills.
  • Self-motivated, follows directions with minimal guidance, excellent communication, documentation, and follow-up skills.
  • High degree of initiative, proven team player.
  • Exceptional oral and written communication skills.

TRAVEL REQUIREMENTS: 25% - 39%

PHYSICAL ENVIRONMENT:

  • Work may be performed in a temperature-controlled environment
  • Must sit, stand, or walk for extended periods of time
  • May spend long periods of time at desk or computer terminal
  • May use calculators, keyboards, telephone, and other office equipment in the course of normal workday
  • Stooping, bending, twisting, and reaching may be required in completion of job duties
  • Workday is fast paced, some evening and weekend work may be required

Disclaimer:

The above statements are intended to describe the general nature and level of work being performed by employees assigned to this job classification. They are not intended to be construed as an exhaustive list of all responsibilities and skills required of personnel so classified.

Keywords: Albertsons Companies, Pleasanton , Clinical Program Manager, Other , Pleasanton, California

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Log In or Create An Account

Get the latest California jobs by following @recnetCA on Twitter!

Pleasanton RSS job feeds