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Health Services WellCare - Health Services Management Careers

Clinical Care - Manager Job

Full Job Title: Mgr, Clinical Care

Job Number: 1800457

Tampa, FL
Louisville, KY
Lexington, KY
Columbia, MO

Date Posted: 5-25-2018

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

Reports to: Dir. Utilization Management

Department: Utilization Management

Location: Corporate-Tampa, FL.

Columbia, MO

Lexington, KY.

Louisville, KY.

Essential Functions:

  • Manages and optimizes workflows to achieve successful quality outcomes and benefit maximization within the scope of responsibilities.
  • Serves as an instrumental partner in monitoring and tracking key performance indicators to include identification of over/under utilization patterns and/or deviation from expected results for assigned area/markets.
  • Monitors processes and procedures to ensure compliance with contractual, regulatory (Federal/State) and accreditation entities.
  • Provides leadership and support to front-line staff and supervisors.
  • Monitors and tracks production and quality driven work products and outcomes to individual performers.
  • Provides guidance for inpatient, outpatient and prior authorization management for future expansion and growth efforts.
  • Leads talent management activities to develop and cultivate future leaders.
  • Performs other duties as assigned.
Candidate Education:
  • Required A High School or GED
  • Preferred A Bachelor's Degree in Nursing or Healthcare field
Candidate Experience:
  • Required 5 years of experience in a acute clinical/surgical setting, current experience in utilization management to include pre-authorization, utilization review, concurrent review, discharge planning, and/or skilled nursing facility reviews
  • Required 1 year experience in leading/supervising others a managed health care setting
Candidate Skills:
  • Intermediate Demonstrated problem solving skills
  • Intermediate Demonstrated interpersonal/verbal communication 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 written communication skills
  • Intermediate Ability to lead/manage others
  • Intermediate Ability to effectively present information and respond to questions from peers and management
  • Intermediate Ability to lead/manage others in a matrixed environment
  • Intermediate Knowledge of healthcare delivery
  • Intermediate Knowledge of community, state and federal laws and resources
  • Intermediate Other Demonstrate effective critical thinking and decision making skills
Licenses and Certifications:
  • Registered Nurse License (RN) Required
Technical Skills:
  • Required Intermediate Microsoft Word Proficient in Microsoft Outlook applications, including Word,Excel, Power Point and Outlook
  • Required Intermediate Microsoft Excel Ability to use proprietary health care management system
  • Required Intermediate Microsoft PowerPoint
  • Required Intermediate Microsoft Outlook
  • Required Intermediate Healthcare Management Systems (Generic)

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Last Updated On: 12/9/2015