Nurse Supervisor - Clin Rev

    Supervises a team of clinical staff with varying professional license and education levels
    Conducts formal performance appraisals according to pre-determined performance metrics and measures of success and documents reviews and recommendations per HR policy at 90 days for newly hired staff and annually for all direct reports 
    Handles and reviews disciplinary actions directly with employees i.e. verbal warnings records of discussion and formal disciplinary documentation. 
    Enables team members to ensure consistent quality service to clients providers and members
    Continuously tracks and monitors program/client team and individual performance metrics and  provides feedback and coaching to ensure performance goals are achieved
    Conducts formal Team and individual staff meetings to disseminate information
    Serves as an additional training resource to improve effectiveness of the clinical assessment process in relation to new program updates and process changes.
    Oversees and evaluates staff work assignments and makes appropriate adjustments to ensure case-specific turnaround times (TAT) related to client service level agreements and regulatory compliance requirements are met for their specified program(s) 
    Partners with Workforce Planning to ensure appropriate resources are allocated to meet workload demand
    Addresses escalated procedural and technical issues and coordinates with the appropriate departments to effectively resolve the issue(s)
    Coordinates with Programs and Client Services to ensure appropriate business processes are being followed and enhancements are being developed and implemented
    Identifies issues related to specific programs and makes suggestions for improving effectiveness and efficiency
    Acts as first level liaison for escalated Client Service issues and actively determines best resolution
    Develop implement and utilize a multifaceted rewards system that makes team members excited to show up to work every day and do their best
    Use empowerment trust and other strategies as appropriate to develop and motivate team members
    Facilitate a healthy and motivating work environment and atmosphere
    Creates encourages and supports an environment that fosters teamwork respect diversity and cooperation with others
    Utilizes knowledge of telephony ACD workforce and related systems to manage daily phone metrics
    Responsible for knowing the intricacies of all benefit management programs including applicable regulatory compliance accreditation standards and client/health plan service level requirements for each program line of business and geographic region 
    Collaborates with human resources to ensure adherence to company policies
    Refers all complaints to director of corporate compliance works collaboratively with the compliance department to investigate complaints and correct errors
    Assists with service restoration efforts during emergencies
    Accurately answers questions regarding Plan benefits for members and providers
    Promotes business focus which demonstrates an understanding to the companys vision mission and strategy
    Utilizes knowledge of telephony ACD workforce and related systems to manage daily phone metrics
    Performs other related duties and projects as assigned
    Adheres to all HIPAA state and federal regulations pertaining to the clinical programs
    Adheres to both URAC & NCQA standards pertinent to their job description
 

Qualifications :

    Current active unrestricted RN or LVN/LPN license in a state or territory of the United States required
    Minimum 3 years experience in UM/QM acute care or managed care setting required 
    Minimum 2 years of progressively responsible supervisory experience in a managed care environment preferred
    Excellent interpersonal written and presentation skills including the ability to handle interactions with facility personnel providers members and various internal departments in a professional manner 
    Proficient leadership and facilitation skills
    Ability to work in a fast-paced evolving environment on-call after hours work may be required 
    Excellent organizational skills
    Highly motivated self-starter who works independently using all available resources policies and procedures to work effectively and meet deadlines in an atmosphere of multiple projects and shifting priorities
    Demonstrated knowledge and experience in using critical thinking skills
    Experience in team interactions and improvement methods/projects (e.g. coaching quality and productivity)
    Knowledge of Microsoft Office and programs including Outlook PowerPoint Excel Word and Visio

Additional Information :

HealthHelp provides equal opportunities to all employees and applicants without regard to race color religion gender sexual orientation gender identity or expression national origin age disability genetic information marital status amnesty or status as a covered veteran in accordance with applicable federal state and local laws. If you need assistance in completing this application due to a disability please contact a member of the Talent Acquisition Group to request an accommodation or an alternative application process by emailing

Remote Work :

Yes

Employment Type :

Full-time