Nurse Team Lead Clin Rev

MAJOR RESPONSIBILITIES
    Balances between case review production and team lead duties based on business needs and staffing levels
    Conducts case reviews as assigned 
o    Maintains a minimum target of 3.5 cases per hour (CPH) when processing cases during productivity hours 
    Monitors staff work assignments and adjusts the nurse assignment tool based on staffing levels proficiency types of request and amount of cases received; frontline staff pull their assignments directly from the tool 
o    Ensures case-specific turnaround time (TAT) related to client service level agreements and regulatory compliance requirements are met for their specified program(s) 
o    Communicate expectations assignments and responsibilities clearly and professionally
o    Acts as a liaison between frontline staff and upper management
    Assists with daily physician reviewer case coordination and notifications
    Monitor team performance to ensure proper processes are being followed and report on areas of opportunity to Supervisor
o    Functions as a subject matter expert for assigned program modalities/procedures 
o    Disseminates information as appropriate to staff members
o    Evaluates and monitors case work by team members to identify any gaps or outliers 
o    Ensures that staff members are successful by providing support to new and existing staff as a valuable resource
o    Listen to team members feedback and resolve any issues or conflicts
o    Enables team members to ensure consistent quality service to provider and members
o    Collaborates with other departments as assigned to ensure proper protocol is being followed and obtain clarifications as needed
    Conducts selected reviews/auditing of cases within the Clinical Review department to identify training opportunities based on appropriateness of the review determinations  
o    Coordinates with Nursing Management and Clinical Review Training Department to identify educational and refresher training needs for individual nurses or across the Clinical Review Department
o    Conducts periodic one-on-ones with Clinical Review Nurses to offer tips on process improvement and clinical review
o    Identify potential improvements in clinical review process and criteria
o    Participate in HH Nurse Education group email to provide responses to nurses questions regarding specific cases and clinical review processes

STANDARD DEPARTMENTAL RESPONSIBILITIES
    Provide secondary Nursing Management coverage for assisting staff during Manager or Supervisor unavailability due to meetings PTO etc.
    Handles escalated inbound calls or requests from providers
    Assists with inventory management including monitoring case volumes and queues to support timely assignment and completion
    Actively participates or conducts meetings as directed by Supervisor or Manager
    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
    Utilizes knowledge of AVAYA ADP Workforcenow. and related systems to manage daily phone metrics
    Capable of collaborating with client personnel to resolve customers concerns 
    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 
    Refers all complaints to Compliance Officer as appropriate; works collaboratively with the Quality Department to investigate complaints and correct errors
    Evaluate and report HIPAA breaches according to policy
    Collaborates with human resources to ensure adherence to company policies
    Promotes business focus which demonstrates an understanding of the companys vision mission and strategy
    Creates encourages and supports an environment that fosters teamwork respect diversity and cooperation with others
    Adheres to all HIPAA state and federal regulations pertaining to the clinical programs
    Adheres to both URAC & NCQA standards pertinent to their job description
    Performs other related duties and projects as assigned

    Please note this job description is not designed to cover or contain a comprehensive list of activities duties or responsibilities that are required of the employee for this job. Duties responsibilities and activities may change at any time with or without notice.

Qualifications :

QUALIFICATIONS
    Graduate of an accredited school of nursing
    Current active unrestricted RN or LVN/LPN license in a state or territory of the United States required
    Minimum of 2 years of Utilization Management (UM) experience required; additional experience in QM acute care or managed care setting 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 
    Demonstrates leadership and motivational skills
    Ability to work in a fast-paced evolving environment on-call after hours work may be required 
    Ability to utilize critical thinking skills
    Experience in team interactions and improvement methods/projects (e.g. coaching quality and productivity)
    Understanding of HealthHelps products and services 
    Strong interpersonal and communication skills 
    Knowledge of Microsoft Office and programs including Outlook PowerPoint Excel Word and Visio 

ENVIRONMENT AND PHYSICAL DEMANDS
    Business office environment or HIPAA compliant remote location
    Ability to use telephone for up to 8 hours unassisted
    Ability to sit for up to 8 hours unassisted
    Ability to enter data for up to 8 hours unassisted
    Ability to view PC screen for up to 8 hours
    Ability to prioritize in a multi-task environment

Additional Information :

Shift 10:30am - 7:00pm

Compensation Disclosure

The base salary for this position is LVN/LPN Team Lead $74880 and RN Team Lead $85280 annually. This represents the base pay range that we reasonably expect to offer for this position.

In addition to base pay this role may be eligible for performance-based bonuses incentive pay or commissions which are not included in the listed base salary range.

WNS complies with all applicable federal state and local pay transparency laws including those in California Colorado New York Washington and Illinois.

Note: For complete compensation information please refer to the job posting on our official careers page.

Equal Opportunity Employer Statement

WNS is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

All qualified applicants will receive consideration for employment without regard to race color religion sex (including pregnancy childbirth or related medical conditions) sexual orientation gender identity or expression national origin age disability genetic information veteran status or any other status protected under federal state or local law.

We also provide reasonable accommodations to individuals with disabilities and for sincerely held religious beliefs in all aspects of employment including the application process.

Benefits Overview

Our benefits package includes (but is not limited to):

- Medical dental and vision insurance

- Paid time off (PTO) holidays and sick leave

- 401(k) with company match or other retirement plan

- Life and AD&D Insurance

- Employee Assistance Program

Equal Opportunity Employer Statement

WNS is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

All qualified applicants will receive consideration for employment without regard to race color religion sex (including pregnancy childbirth or related medical conditions) sexual orientation gender identity or expression national origin age disability genetic information veteran status or any other status protected under federal state or local law.

We also provide reasonable accommodations to individuals with disabilities and for sincerely held religious beliefs in all aspects of employment including the application process.

How to Apply

Please submit your application including a resume and optional cover letter through our careers page or email to

Remote Work :

Yes

Employment Type :

Full-time