Clinical Program Manager
Company: Albertsons Companies
Posted on: June 3, 2021
Clinical Program Manager
Join an integrated multidisciplinary team to impact the health
and wellbeing of employees in this dynamic Clinical Program Manager
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.
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
- 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:
- 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.
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
- Knowledgeable in utilization review/utilization management
regulatory requirements, practices, and procedures across multiple
- 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
- 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
- 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%
- Work may be performed in a temperature-controlled
- Must sit, stand, or walk for extended periods of time
- May spend long periods of time at desk or computer
- 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
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
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