Shire Jobs

Director, Clinical Operations Central Nursing at Somatus

Remote

Summary :

The Clinical Director takes a leadership role in the analysis of standard operating processes, identifies clinical process variances, and remediates with key stakeholders throughout the organization that track

and analyze SLA performance metrics, Somatus KPIs, and HEDIS measures. The Clinical Director leverages data to derive advanced analytical insights allowing for enhanced

clinical processes that lead to improved member outcomes. Using this data, they coordinate and develop workflows with end-to-end cross functional process management.

Essential Duties and Responsibilities:

▪ Perform audits with root cause analysis of adherence to Somatus workflows, protocols, best

practices, and documentation expectations as it relates to SLAs, KPIs, and HEDIS.

▪ Collaborate with executive leadership regarding clinical informatics and technology.

▪ Promote network alignment of informatics initiatives with clinical practice standards, guidelines,

and regulatory standards as well as appropriate use of innovative technologies.

▪ Facilitate ongoing development of Somatus care management platform inclusive of cross

functional areas.

▪ Support training and re-training efforts and identify gaps where additional staff training/coaching

is needed; facilitate ongoing training in the markets.

▪ Contributes to Operational Initiatives and supports the AVP of Central Operations in analysis

and project efforts through data collection, report preparation, project collaboration.

▪ Reports/resolves issues and system barriers to efficient and effective care management.

▪ Participates in team meetings, performance improvement, and patient satisfaction initiatives.

▪ Collaborative partnerships with Technology, Finance, Population Health Product & Innovation,

Data Engineers, and Human Resources.

▪ Maintains compliance with organizational policies, procedures, evidence-based guidelines, and

NCQA compliance.

▪ Clinical EMR liaison, reviews and anticipated enhancements and additional builds to support

business needs and functionality

Please note this job description is not designed to cover or contain a comprehensive listing of activities,

duties or responsibilities that are required of the employee for this job. Duties, responsibilities and

activities may change at any time with or without notice.

Required Education and Experience:

• RN, BSN

Knowledge, Skills, and Abilities:

• 10+ years of management experience in case management, kidney care management, or KPI

improvement

• Strong interpersonal and customer service skills required to communicate with team members,

providers, and internal stakeholders.

• Must possess strong problem-solving abilities, analytical skills, and collaboration skills.

• Demonstrates, after training, ability to use all applicable electronic systems/applications

including population management systems to input, retrieve, and manipulate clinical

information. Must be highly attentive to detail, accuracy, and achieving end results.

• Utilizes critical thinking and good judgement in performance of tasks.

• Must possess good organizational skills and the ability to multitask and to prioritize daily

assignments to ensure smooth workflow.

• Intermediate skills with Microsoft applications which may include Word, Excel, PowerPoint, and

other web-based applications. May produce complex documents, perform analysis, and maintain

databases.

• Understands and complies with highest standards of confidentiality.

• Excellent presentation, interpersonal and relationship-building skills.

• Positive and inspiring team leadership style to drive outcomes and company KPI’s

• Knowledge and experience to coach team members to empower patients in self-management and

shared decision making.

• Motivated to drive change and result driven

Physical Requirements

▪ Must be able to sit for long periods of time

▪ Prolonged use of typing

OTHER DUTIES:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Our priority is the health and safety of our members, colleagues, partners, and community. Proof of COVID-19 Vaccination is required for employment. If you are unable to be vaccinated for medical reasons or sincerely-held religious beliefs, we will consider requests for reasonable accommodations consistent with our policy, and where we are able to provide such accommodations without undue hardship to the company. All requests for proof of vaccination or for exemptions from the vaccination requirement will be subject to any limitations stipulated by current state and/or federal laws.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions .

Somatus, Inc. provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by state, federal, or local law. Further, the company takes affirmative action to ensure that applicants are employed, and employees are treated during employment without regard to any of these characteristics. Discrimination of any type will not be tolerated.