Supv, Clinical Care

Oversees the day to day operations for inpatient, outpatient and prior authorization management activities to achieve quality and service driven objectives.

Essential 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 procedure
  • Prepares 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.
Additional Responsibilities:
    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 skills
    • Intermediate Knowledge of community, state and federal laws and resources
    • Intermediate Ability to effectively present information and respond to questions from families, members, and providers
    • Intermediate Ability to work within tight timeframes and meet strict deadlines
    • Intermediate Demonstrated interpersonal/verbal communication skills
    • Intermediate Demonstrated written communication skills
    • Intermediate Ability to lead/manage others
    • Intermediate Ability to effectively present information and respond to questions from families, members, and providers
    • Intermediate Ability to effectively present information and respond to questions from peers and management
    • Intermediate Other Previous experience working with treatment teams to meet the healthcare needs of participants
    • Intermediate Ability to lead/manage others in a matrixed environment
    • Intermediate Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions
    • Intermediate Other Knowledge of utilization management principles and criteria sets
    • Intermediate Other 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 Excel
    • Required Intermediate Microsoft Word
    • Required Intermediate Microsoft Outlook
    • Required Intermediate Microsoft PowerPoint
    • Required Intermediate Healthcare Management Systems (Generic)
    Languages:

      About us
      Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses exclusively on providing government-sponsored managed care services through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans to families, children, seniors and individuals with complex medical needs. WellCare is a Fortune 500 company, and in 2018, was recognized as a Fortune "World's Most Admired Company", ranking in the top five among the health insurance and managed care industry-a testament to the hard work and dedication of the company's nearly 9,000 associates who each day live WellCare's values and deliver on its mission to help its members live better, healthier lives. The company serves approximately 4.4 million members nationwide as of Dec. 31, 2017. For more information about WellCare, please visit the company's website at www.wellcare.com. 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.