Clinical Operations Manager
Provider Partners Health Plan
On-site
Indianapolis, Indiana, United States
Administration, Operations & Management
Job Summary:
The Provider Partners Clinical Management (PPCM) Clinical Operations Manager (COM) is
responsible for providing local market clinical leadership and oversight for the health plan.
Under the general direction of the Director of Clinical Operations, the COM coordinates care
between the partnering SNF’s clinical leadership, the SNF interdisciplinary care team, and the
PPCM clinical team to ensure delivery of excellent, compassionate and personalized health care
as the Model of Care (MOC) promises.
The COM has direct oversight of the day-to-day clinical operations of the market, including
supporting quality health care delivery, clinical proficiencies, utilization management, and
business development while adhering to the PPCM Model of Care and other
regulatory/accreditation guidelines. The PPCM medical model also provides additional
concierge services, as well. Additionally, the Clinical Operations Manager is directly responsible
for management and development of the PPCM clinical team which consists of Senior
Clinicians, Nurse Practitioners (NPs) and Registered Nurse Care Coordinators (RNCC’s).
Having a strong ambassador element for the health plan, this role requires time in the field
collaborating and coordinating care with the clinical leadership and interdisciplinary care teams
at partnered and potential skilled nursing facilities.
Key ResponsibiliƟes:
• Serve as local clinical ambassador for the program providing clinical and strategic
leadership to ensure the provision of excellent and efficient quality of care in
accordance with the PPCM MOC
• Track progress, identify barriers, and implement strategies to meet established market
utilization and quality metrics.
• Maintain knowledge and achieve compliance with federal, state and local regulatory
requirements, licensure, accreditation requirements
• Design, develop, and implement strategic initiatives, educational programs, policies and
procedures for efficient clinical operations and achievement of financial and quality
metrics
• Assist in maintaining financial objectives and cost improvement programs for the
assigned market
• Support new market development efforts with partnering entities
• Collaborate with PPHP/PPCM senior leadership to drive performance and establish
innovation within the company
• Interact with attending physicians and skilled nursing facility medical directors to
establish successful working relationships for the health plan
• Support corporate functions such as NP auditing, documentation management,
HEDIS/Stars quality measures, and policies & procedures.
• Manage and report utilization results against targets for acute and SNF admissions, Part
A and B skilled services
• Assists with stretch assignments as needed
• Support human resource management of the Senior Clinicians and NP’s, including
functions such as hiring, terminations, and performance evaluations.
• Support staff development emphasizing teamwork and a culture of accountability by
mentoring staff and providing frequent and constructive feedback.
• Mentor staff towards career growth/succession planning efforts with special emphasis
on retaining and recruiting a diverse work force
QualificaƟons:
• Current certification as an Adult, Geriatric or Family Nurse Practitioner in the state of
practice.
• Current unrestricted RN license for the state in of practice.
• Holds or is eligible for DEA licensure and CDS licensure (if required in the state of
practice)
• Meets PPCM credentialing requirements.
• Holds current Basic Life Support certification.
• Holds valid driver’s license and car insurance and has reliable transportation
Minimum of 5 years clinical care & management experience
• Skilled Nursing Facility/Long Term Care experience
• Case management experience
• Knowledge CMS regulations and core aspects of an ISNP program.
• Experience in development of clinical operations, quality management, and
performance management.
• Proficient at creating operational efficiencies and project management.
• Proficient in basic computer skills, virtual meeting platforms, Microsoft and LTC clinical
EMRs.
• Clear, concise, and persuasive verbal and written communication.
• Adept at interacting with members and their families, other clinicians, senior leadership,
and all levels of medical and non-medical professionals.
• Solid teaching skills
• Good interpersonal & organizational skills with attention to detail
• Strong commitment to excellent customer service
• Positive and enthusiastic attitude.
• Must be highly motivated, organized, flexible and adaptable to working in a fast-paced,
dynamic environment.
• Must hold self to a high level of autonomy and accountability.
The Provider Partners Clinical Management (PPCM) Clinical Operations Manager (COM) is
responsible for providing local market clinical leadership and oversight for the health plan.
Under the general direction of the Director of Clinical Operations, the COM coordinates care
between the partnering SNF’s clinical leadership, the SNF interdisciplinary care team, and the
PPCM clinical team to ensure delivery of excellent, compassionate and personalized health care
as the Model of Care (MOC) promises.
The COM has direct oversight of the day-to-day clinical operations of the market, including
supporting quality health care delivery, clinical proficiencies, utilization management, and
business development while adhering to the PPCM Model of Care and other
regulatory/accreditation guidelines. The PPCM medical model also provides additional
concierge services, as well. Additionally, the Clinical Operations Manager is directly responsible
for management and development of the PPCM clinical team which consists of Senior
Clinicians, Nurse Practitioners (NPs) and Registered Nurse Care Coordinators (RNCC’s).
Having a strong ambassador element for the health plan, this role requires time in the field
collaborating and coordinating care with the clinical leadership and interdisciplinary care teams
at partnered and potential skilled nursing facilities.
Key ResponsibiliƟes:
• Serve as local clinical ambassador for the program providing clinical and strategic
leadership to ensure the provision of excellent and efficient quality of care in
accordance with the PPCM MOC
• Track progress, identify barriers, and implement strategies to meet established market
utilization and quality metrics.
• Maintain knowledge and achieve compliance with federal, state and local regulatory
requirements, licensure, accreditation requirements
• Design, develop, and implement strategic initiatives, educational programs, policies and
procedures for efficient clinical operations and achievement of financial and quality
metrics
• Assist in maintaining financial objectives and cost improvement programs for the
assigned market
• Support new market development efforts with partnering entities
• Collaborate with PPHP/PPCM senior leadership to drive performance and establish
innovation within the company
• Interact with attending physicians and skilled nursing facility medical directors to
establish successful working relationships for the health plan
• Support corporate functions such as NP auditing, documentation management,
HEDIS/Stars quality measures, and policies & procedures.
• Manage and report utilization results against targets for acute and SNF admissions, Part
A and B skilled services
• Assists with stretch assignments as needed
• Support human resource management of the Senior Clinicians and NP’s, including
functions such as hiring, terminations, and performance evaluations.
• Support staff development emphasizing teamwork and a culture of accountability by
mentoring staff and providing frequent and constructive feedback.
• Mentor staff towards career growth/succession planning efforts with special emphasis
on retaining and recruiting a diverse work force
QualificaƟons:
• Current certification as an Adult, Geriatric or Family Nurse Practitioner in the state of
practice.
• Current unrestricted RN license for the state in of practice.
• Holds or is eligible for DEA licensure and CDS licensure (if required in the state of
practice)
• Meets PPCM credentialing requirements.
• Holds current Basic Life Support certification.
• Holds valid driver’s license and car insurance and has reliable transportation
Minimum of 5 years clinical care & management experience
• Skilled Nursing Facility/Long Term Care experience
• Case management experience
• Knowledge CMS regulations and core aspects of an ISNP program.
• Experience in development of clinical operations, quality management, and
performance management.
• Proficient at creating operational efficiencies and project management.
• Proficient in basic computer skills, virtual meeting platforms, Microsoft and LTC clinical
EMRs.
• Clear, concise, and persuasive verbal and written communication.
• Adept at interacting with members and their families, other clinicians, senior leadership,
and all levels of medical and non-medical professionals.
• Solid teaching skills
• Good interpersonal & organizational skills with attention to detail
• Strong commitment to excellent customer service
• Positive and enthusiastic attitude.
• Must be highly motivated, organized, flexible and adaptable to working in a fast-paced,
dynamic environment.
• Must hold self to a high level of autonomy and accountability.