Director of Clinical Operations

1 week ago


Jackson, Mississippi, United States Oceans Healthcare Full time
Director of Clinical Operations

Oceans Healthcare is seeking a highly skilled and experienced Director of Clinical Operations to oversee the management of all clinical review and case management activities for our inpatient, partial hospitalization, and outpatient programs.

Key Responsibilities:
  • Conduct thorough audits of medical records to ensure compliance with regulatory requirements and ensure that criteria for admission and continued stay are met and documented.
  • Coordinate information between third-party payers and clinical staff members to ensure seamless communication and efficient utilization of resources.
  • Interact with members of the clinical team to provide a flow of communication and a medical record that documents and supports the level and intensity of service rendered.
  • Identify and report on opportunities for improvement in the use of services and resources, including under-use, over-use, and inefficient use.
  • Oversight of daily reviews of all inpatient, partial hospitalization, and outpatient records to ensure compliance with regulatory requirements.
  • Reports findings to appropriate disciplines and/or committees to inform decision-making and drive improvement.
  • Coordinates the flow of communication between physicians/staff and third-party payers concerning reimbursement requisites and ensures timely resolution of issues.
  • Attends meetings to obtain third-party payer pre-certification and ongoing certification requirements to ensure compliance.
  • Maintains coordination of information requests from third-party payers and Oceans Payer Engagement team to ensure efficient communication and resolution of issues.
  • Communicates to staff the status of new/existing contracts and ensures that all necessary information is shared in a timely manner.
Requirements:
  • Bachelor's degree in a healthcare-related field or equivalent work experience.
  • At least two years of experience in a psychiatric/chemical dependency setting with good working knowledge of psychiatric/medical principles.
  • At least two years of supervisory experience with a proven track record of leadership and management.
Qualifications/Skills:
  • Excellent communication, management, and leadership skills with the ability to motivate and inspire a team.
  • Working knowledge of healthcare operations and management principles, including regulatory requirements and reimbursement models.
  • Good writing and composition skills with the ability to communicate complex information in a clear and concise manner.
  • Ability to organize and prioritize high-volume workloads and manage multiple projects simultaneously.
  • Strong working knowledge of clinical review and case management processes, including data analysis and interpretation.
  • Knowledge and understanding of regulatory and fiscal reimbursement and utilization review as a primary component of patient care.
  • Strong patient advocacy skills with the ability to balance the needs of patients, families, and stakeholders.
  • Ability to analyze and utilize data and systems to provide individualized quality care in a cost-effective manner.
Work Environment:

This position requires spending approximately 90% or more of the time inside a building that offers protection from weather conditions but not necessarily from temperature changes.



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