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Supervisor, Clinical Care RN - Outpatient

Company: WellCare
Location: Tampa
Posted on: July 14, 2019

Job Description:

Oversees the day to day operations for inpatient, outpatient and prior authorization management activities to achieve quality and service driven objectives. DEPARTMENT: PHS-OutpatientREPORTS TO: Sr. Mgr. Prior AuthorizationEssential Functions: Supervises a staff of nurses to achieve successful quality outcomes and benefit maximization towards members care.Supervises processes and procedures to ensure compliance with contractual, regulatory (Federal/State) and accreditation entities.Provides leadership and support to front-line staff.Monitors and tracks production and quality driven work/outcomes on assigned staff.Monitors associates' performance, productivity and quality through standard reports.Conducts one-on-one coaching and provides associates feedback routinely and as needed.Provides counseling/corrective action procedures when required.Maintains documentation of performance including attendance and disciplinary actions.Provides significant input into associates' performance evaluations and hiring/terminations.Manages the E-time process - including training and education.Conducts training for new associates and re-training based on changing policy and procedurePrepares and completes projects, reports and assignments as needed to meet departmental goals and initiatives.Attends company meetings in absence of manager.Makes process improvement recommendations to management.Act as primary contact for escalated calls and/or escalated issues or that require additional research and/or special handling.Investigates issues of an unusual nature and proposes solutions in a clear and concise manner. Demonstrates appropriate customer-care skills such as empathy, active listening, courtesy, politeness, helpfulness and other skills as identified. Performs other duties as assigned. Candidate Education: Required a High School or GED Preferred a Bachelor's Degree in a related field Candidate Experience:Required 4 years of experience in a clinical or utilization management setting with exposure to pre-authorization, utilization review, concurrent review, and/or discharge planning.Required 1 year experience in leading/supervising others In a clinical or managed care setting (preferred) where you functioned in a team lead or senior capacity, providing mentoring, training, support, and guidance and functioned as a subject matter expert (SME). Candidate Skills:Intermediate demonstrated problem solving skillsIntermediate knowledge of community, state and federal laws and resourcesIntermediate ability to effectively present information and respond to questions from families, members, and providersIntermediate ability to work within tight timeframes and meet strict deadlinesIntermediate demonstrated interpersonal/verbal communication skillsIntermediate demonstrated written communication skillsIntermediate ability to lead/manage othersIntermediate ability to effectively present information and respond to questions from families, members, and providersIntermediate ability to effectively present information and respond to questions from peers and managementIntermediate previous experience working with treatment teams to meet the healthcare needs of participantsIntermediate ability to lead/manage others in a matrixed environmentIntermediate ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusionsIntermediate knowledge of utilization management principles and criteria setsIntermediate strong clinical knowledge of broad range of medical practice specialties Licenses and Certifications:A license in one of the following is required: Required Licensed Registered Nurse (RN) Technical Skills:Required intermediate Microsoft ExcelRequired intermediate Microsoft WordRequired intermediate Microsoft OutlookRequired intermediate Microsoft PowerPointRequired intermediate Healthcare Management Systems (Generic) About usHeadquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.

Keywords: WellCare, Tampa , Supervisor, Clinical Care RN - Outpatient, Healthcare , Tampa, Florida

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