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Corporate Functions & Operations WellCare - Clinical Support Careers

Clinical Care - Supervisor Job

Full Job Title: Supv, Clinical Care

Job Number: 1805375

Location: Tampa, FL

Date Posted: 2018-08-09

Department: Health Services-Inpatient Care Mgmt
Reports to: Sr. Manager Clinical Care
Location: 8715 Henderson Road, Tampa, FL 33634
WellCare has an exciting opportunity for an experienced Supervisor of Clinical Care to join our team! This is a new position due to growth. This role supervises 10 associates who typically work remotely but some are in office. Candidate must be a registered nurse (RN), have 4 years of experience in clinical or utilization management/pre-authorization, utilization review, discharge planning, etc. Additionally, the selected candidate will have a minimum of one year of supervisory experience.
Our ideal candidate will be someone that understands metrics and standards and drives production in a timely manner. S/he will embrace coaching their associates so everyone effectively meets or exceeds goals in addition to fostering an environment of professional development. Lastly, this person will be a proficient user of Excel as there is a lot of filtering and maneuvering in various reports. InterQual experience a solid plus.
PLEASE NOTE: This exempt position is work from work at our Tampa campus with general hours of 8-5. This is a full-time, direct hire position with an outstanding benefits package and full cafeteria and fitness center on campus.

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)

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      Last Updated On: 12/9/2015