Medical Policy Manager jobs in Bremerton, WA

CHI Franciscan and Virginia Mason are now united to build the future of patient-centered care across the Pacific Northwest. That means a seamlessly connected system offering quality care close to home. From basic health needs to the most complex, highly specialized care, our patients can count on us to meet their needs with convenient access to the region’s most prestigious experts and innovative treatments and technologies.  

While you’re busy impacting the healthcare industry, we’ll take care of you with benefits that may include health/dental/vision, FSA, matching retirement plans, paid vacation, adoption assistance, annual bonus eligibility, and more!

Franciscan Medical Group, a part of Virginia Mason Franciscan Health, is currently seeking a full time Clinic Manager, Registered Nurse for our Franciscan Cardiology Consultants in SIlverdale, WA. We are currently seeking a dedicated Nurse Leader to join our team and contribute to our mission of providing exceptional care and leadership in a supportive environment. No weekends, nights or organizationally recognized holidays required! 

Job Summary:

This job is responsible for planning, managing and evaluating the daily operations of the assigned CHI Franciscan Medical Group clinic(s) in close collaboration with the Medical Director/Operations Director and in accordance with business objectives, internal policies/procedures and applicable regulatory requirements.  Work involves proactively monitoring a variety of clinical/operational elements and maintaining constant awareness of changing conditions in order to quickly identify and reassess ongoing needs and to ensure that clinic activities are adjusted appropriately to meet expectations/demand in a timely, efficient and effective manner. 

An incumbent anticipates/plans for future changes, and works collaboratively with physicians/staff and other stakeholders to assure optimal clinic productivity/patient flow, customer service and effective allocation of resources.  Work is performed within scope of licensure and is strongly focused on creating strong, positive and sustained inter-departmental teamwork to meet the needs of patients/providers and drive decision-making and other actions. 

Work includes: 1) identifying/implementing timely performance/process improvement opportunities; 2) monitoring/reporting clinic metrics/results; 3) collaborating with HR employment team in support of recruitment/retention strategies to maintain optimal clinic staffing; 4) overseeing the resolution of complaints/service issues to facilitate positive customer experience; 5) developing/administering clinic budget; 6) coordinating clinic patient care, security, risk management, disaster readiness and facilities upkeep/maintenance activities; and 4) managing/evaluating the work of clinic staff.

Work requires a solid understanding of both the business and clinical side of clinic administration as well as policies/standards/procedures, quality/growth objectives and knowledge of clinic patient care services and work flow.  Also requires the ability to listen effectively, exercise significant tact and diplomacy in eliciting factual data from sometimes upset/irate individuals and take proper action to assure that issues/complaints are responded to and documented in a timely and professional manner consistent with the service excellence and recovery strategies of the organization.

Essential Job Duties:

Operational Accountability

• Manages and evaluates the daily operations/resources of the assigned clinic (including patient accounts, insurance referrals, nursing staff and clinicians) to assure the safe/appropriate delivery of patient care and that all activities are conducted in a timely and cost-effective manner and in accordance with budget constraints, internal policies/standards/procedures and/or applicable regulatory requirements; coordinates purchase/stocking of clinic supplies, materials and equipment; implements and enforces quality control/quality assurance and productivity standards.
• Coordinates nursing operations and front and back office operational activities to assure sustained compliance with applicable regulations and that clinic standards of quality patient care/confidentiality are maintained; evaluates patient care needs within scope of licensure and provides timely solutions to patient care issues and complaints.
• Identifies and provides guidance in resolving operational/clinical issues (within scope of licensure) and escalates per established procedures to assure timely follow-up and resolution; ensures that applicable standards, systems and procedures are understood and followed; monitors and audits related documentation to ensure conformance with established standards relating to timeliness and accuracy; prepares periodic productivity reports and program updates for review of higher-level authority; serves as liaison between clinic and external agencies.
• Oversees the review of patient/family/physician issues/concerns in support of an environment of proactive service recovery; provides general consultation/guidance to facilitate optimal outcomes for individual complaints; coordinates and/or prepares written responses to complaining parties to communicate/implement approved resolutions; assures proper response to patient-related feedback within established service level agreements and that the resolution is appropriately managed and clearly documented.
• Monitors clinic adherence to applicable environment of care standards and related guidelines; coordinates activities associated with the maintenance and upkeep of clinic facilities, including working with external vendors, property management, contractors, and internal CHI-FH maintenance staff as necessary; reports/documents issues and coordinates appropriate resolution; coordinates with internal departments to ensure clinic disaster readiness and physical security.
• Participates in the planning, development and implementation of new/revised CHI Franciscan Medical Group policies, standards and processes/workflow (e.g. medical support systems, marketing, infection control, billing, etc.), as well as clinic-specific initiatives/procedures focused on increasing/maintaining patient volumes and satisfaction; informs staff and leadership members of any changes to policies and procedures.
• Establishes/maintains effective relationships with regional management and clinic Medical Director in order to provide timely status updates on clinic operations and to facilitate speedy resolution of emerging operational issues; partners in a dyad relationship with clinic Medical Director to guide and direct provider meetings.

Staff Management, Engagement and Development

• Plans, manages and evaluates the work of assigned staff in accordance with established procedures; interviews job candidates and makes employment and other personnel decisions within scope of position; recommends adequate staffing levels for appropriate coverage to meet budgetary and operational objectives.
• Assures that staff are qualified and properly trained/developed to perform assigned job duties; holds regular staff meetings and keeps employees appraised of all matters relevant to successful job performance; communicates performance standards and actively manages employee performance by setting individual goals and completing performance appraisals;
• Trains, guides, counsels, develops and recognizes staff in order to facilitate achievement of performance expectations and standards; utilizes best practice performance management techniques (e.g. rounding, meetings, feedback interviews, etc.); addresses performance management concerns and technical issues elevated by subordinates as beyond their scope of authority.

Resource Management/Budget Administration

• Prepares, recommends and administers clinic budget, including goals/objectives that take into consideration input from clinic staff; oversees clinic resources and related activities in a manner that is fiscally responsible and in accordance with CHI FMG policies and standards.
• Exercises effective cost control by monitoring and adjusting expenses as need to stay within budget; approves expenditures within defined scope of responsibilities; identifies negative variances and develops action plan(s) to document, address and effectively resolve in a timely manner; keeps high level management Director appraised of all issues with potential budgetary impact.

Performance/Quality Improvement

• Monitors and assesses current operations to identify opportunities for new quality/performance/process improvement initiatives; facilitates and/or oversees meetings to discuss methods for improving customer service and efficient/safe operations; makes recommendations to higher level management per established procedures.
• Ensures that new procedures resulting from performance improvement activities are implemented in a timely and effective manner; assures that staff receive appropriate on-site training/consultation to enhance their understanding of quality/performance improvement initiatives and approved changes.
• Manages (and/or leads) assigned clinic-specific projects that may have a broader impact (e.g. entire region and/or system); performs special clinic and/or network-wide projects as assigned to promote public and community relations.

Regulatory Compliance

• Ensures compliance with internal/external legal and regulatory standards/requirements and that effective control procedures are in place and fully functioning to preclude future improprieties from occurring; coordinates timely and compliance training for providers/staff; monitors the effectiveness of current practices in meeting expectations and producing desired results.
• Keeps abreast of changing regulatory requirements/regulation, professional standards and competitive industry practices impacting assigned clinic(s), as well as organizational initiatives/changes with potential to impact current processes and work flow; determines nature/scope of impact on existing activities and recommends effective response/solution while maintaining acceptable service levels and work quality.

Performs related duties as required.

Education/Work Experience Requirements:

Bachelor’s Degree in related field, graduation from an accredited school of nursing, and minimum of three years leadership experience; OR graduation from an accredited school of nursing and five years of leadership experience in the discipline that would demonstrate attainment of the requisite job knowledge/abilities, OR graduation from an accredited school of nursing and Master’s degree and no experience.  Three years of RN experience is strongly preferred.

Licensure/Certification:

Current licensure as a Registered Nurse by the Washington State Board of Nursing.