Senior Manager Clinical Network Operations at Paradigm – Walnut Creek, California

• Network Recruitment, Selection and Development
  • Contribute to the recruitment, application, and selection process for Network business partners and Network Manager candidates in collaboration with the Workforce Development team and Selection Committee leaders.
  • Support the oversight of clinical network onboarding and readiness to function independently.
• Preceptor Program Oversight
  • Assist the Senior Director in the oversight of the Clinical Preceptor Manager, network business preceptors, and PMD preceptors.
  • Contribute to the management and oversight of all precepting programs, including ensuring completion of required preceptor training.
  • Audit precepting activities for quality and compliance with established procedures.
  • Lead and support preceptor meetings in conjunction with the Senior Director, Clinical Network Operations, and the Clinical Preceptor Manager.
  • Analyze preceptor evaluation metrics and implement continuous quality improvement initiatives.
  • Collaborate with clinical training staff to ensure development, implementation, and availability of supporting training materials.
• Performance Management and Issue Resolution
  • Support performance management of clinical networks for risk products by analyzing performance metrics, developing action plans, and collaborating with business owners and internal partners.
  • Investigate network complaints, resolve performance concerns, and assist with customer service issues related to PMC performance.
  • When necessary, communicate directly with customers and injured workers in partnership with internal team members.
• Policy, Procedure and Compliance
  • Contribute to the development, implementation, and monitoring of policies and procedures with operational impact to Paradigm’s Networks.
  • Ensure case management practice guidelines, internal field perspectives, and marketplace requirements are integrated into operational design and procedures.
  • Utilize industry-standard guidelines and references, including:
    • CCMC Code of Professional Conduct
    • CMSA Standards of Practice
    • ACOEM, ODG, and jurisdictional workers’ compensation requirements
• Security and Incident Management
  • Assist the Senior Director with PMC security incidents for risk networks.
  • Support investigation, documentation, and reporting of all security-related incidents involving PMCs in collaboration with the Senior Director and Clinical Preceptor Manager.
• Clinical Summit and Special Projects
  • Contribute to Catastrophic Clinical Summit planning, including ensuring appropriate operational and financial support.
  • Participate in and lead Summit project workgroups as assigned.
  • Serve as a designated back-up for the Senior Director, Clinical Network Operations during time off or periods of conference scheduling overload.
• Quality Assurance and Training
  • In collaboration with the Network Quality Analyst, develop, implement, and support Quality Assurance initiatives with network-wide clinical impact.
  • Intervene with clinical staff based on quality data analysis and provide performance recommendations to Network Services leadership.
  • Contribute as a developer and editor to training programs, network communications, and company-sponsored clinical education initiatives.
• Operational Coverage and Industry Engagement
  • Provide weekend coverage for referral handling on a rotating basis with other managers.
  • Maintain a comprehensive clinical knowledge base and awareness of industry trends, standards, and current events related to workers’ compensation, medical economics, and healthcare.

Qualifications:

• Bachelor’s degree in nursing or health care specialty from an accredited university considered (must possess certification and relevant experience). Master’s Degree preferred.
• Licensed Registered Nurse (RN) preferred with active, unrestricted licensure.
• CCM, CRRN or CNE, Nursing Professional Development certification preferred.
• Minimum 5-7 years of experience in the management of clinical resources, demonstrated knowledge of case management services provided for catastrophically injured individuals with CCM certification required.
• Thorough knowledge of healthcare delivery systems, standards of care for catastrophic diagnoses, case management, public and private resources required.
• Prior experience with mentoring, skill development, and teaching the adult learner.
• Prior experience using a variety of instructional tools and technology in developing high-quality, and engaging learning materials.
• Excellent verbal and written communication skills. Demonstrated ability to simplify complex material for learning and development, utilize negotiation/conflict resolution skills to resolve issues, and provide creative solutions and ideas.
• Able to travel as needed.