Manager - Medical Guidelines & Training
5 days ago
Lead the development, implementation, and continuous improvement of clinical guidelines, training programs, and clinical rules automation to ensure high-quality, evidence-based patient care. This role will focus on enhancing clinical decision-making, ensuring compliance with regulatory policy, and optimizing operational efficiency through strategic guideline management and staff education
Development and Implementation of Clinical Guidelines
- Design, develop, and implement evidence-based clinical guidelines aligned with regulatory requirements.
- Conduct regular reviews and updates of clinical guidelines to reflect the latest medical evidence and industry best practices.
- Collaborate with clinical leaders and subject matter experts to ensure guideline relevance and effectiveness.
Training and Education Programs
- Develop comprehensive training programs for BCC & BA medical staff on clinical guidelines, coverage policies, and decision-making protocols.
- Organize regular workshops, e-learning modules, and competency assessments to maintain high standards of clinical practice.
- Evaluate training effectiveness and implement continuous improvements based on feedback and performance outcomes
Monitoring Adherence and Clinical Quality
- Establish monitoring systems in collaboration with QI to assess compliance with clinical guidelines across BCC & BA.
- Provide regular reports on guideline performance and adherence trends.
- Lead the development & validation of clinical edits and rules for claims/ PA auto-adjudication, ensuring accuracy and alignment with clinical guidelines.
- Continuously review and update rules to reflect changes in clinical guidelines and regulatory standards
Collaboration with Healthcare Providers
- Work closely with the Population Health, Quality Improvement, and Digital Innovation teams to align clinical guidelines with broader healthcare strategies.
- Engage with regulatory bodies to ensure compliance with CHI and IA published guidelines
Patient Safety and Satisfaction
- Promote patient safety and satisfaction through effective guideline implementation.
- Integrate patient safety measures into clinical guidelines and training programs.
- Collect and analyze patient feedback related to care quality and adherence to guidelines.
- Address any identified gaps in patient safety and ensure timely updates to guidelines
Professional Development and Compliance
- Stay updated on emerging healthcare trends, regulatory changes, and best practices in clinical governance.
- Ensure ongoing professional development and compliance with regulations.
- Stay updated on changes in clinical guidelines, regulatory requirements, and best practices.
- Facilitate opportunities for continuous education and professional development for clinical staff.
- Conduct audits to ensure compliance with clinical guidelines and regulatory standards
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