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- Senior Manager Clinical Network Operations
Description
Location: United States
Req Number: Req #1706
Paradigm is an accountable specialty care management organization focused on improving the lives of people with complex injuries and diagnoses. The company has been a pioneer in value-based care since 1991 and has an exceptional track record of generating the very best outcomes for patients, payers, and providers. Deep clinical expertise is the foundation for every part of Paradigm's business: risk-based clinical solutions, case management, specialty networks, home health, shared decision support, and payment integrity programs.
We're proud to be recognized—again! For the fourth year in a row, we've been certified by Great Place to Work®, and for the third consecutive year, we've earned a spot on Fortune's Best Workplaces in Health Care™ list. These honors reflect our unwavering commitment to fostering a positive, inclusive, and employee-centric culture where people thrive.
The Surprising Truth About Case Management - Paradigm
Watch this short video for a brief introduction to role of a nurse case manager at Paradigm.
- 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.
Paradigm Benefits:
Paradigm believes that fostering a diverse and inclusive workplace is central to our mission of helping more people and transforming lives. We're striving to build a culture that better reflects the society we live in and empowers our team to deliver the highest levels of compassion and care to those we serve. For us, achieving this goal requires a workforce that respectfully embraces differences and commits to positive change, creating an environment where everyone is able to bring their whole self to work.
Paradigm complies with federal and state disability laws and makes reasonable accommodations for applicants and employees with disabilities. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact Leave Management at leave.management@paradigmcorp.com.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
As a contractor with the State of Wisconsin, Paradigm complies with Wisconsin Contract Compliance Law (§16.765). Poster link: Contract Compliance Law Poster
Other details
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