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Corporate Functions & Operations WellCare - Clinical Support Careers

Clinical Care - Supervisor Job

Full Job Title: Supervisor, Clinical Care

Job Number: 1703798

Brentwood, TN
St Louis, MO
Tampa, FL

Date Posted: 9-15-2017

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.
Candidate Education:
  • High School or GED is required
  • Bachelor's Degree in a related field is preferred
Candidate Experience:
  • 4 years of experience in A clinical or utilization management setting with exposure to pre-authorization, utilization review, concurrent review, and/or discharge planning is 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) is required
Candidate Skills:
  • Demonstrated problem solving skills
  • Knowledge of community, state and federal laws and resources Knowledge of community, state and federal laws and resources
  • Ability to effectively present information and respond to questions from families, members, and providers
  • Ability to work within tight timeframes and meet strict deadlines
  • Demonstrated interpersonal/verbal communication skills
  • Demonstrated written communication skills
  • Ability to lead/manage others
  • Ability to effectively present information and respond to questions from families, members, and providers
  • Ability to effectively present information and respond to questions from peers and management
  • Previous experience working with treatment teams to meet the healthcare needs of participants
  • Ability to lead/manage others in a matrixed environment
  • Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions
  • Knowledge of utilization management principles and criteria sets
  • Strong clinical knowledge of broad range of medical practice specialties
Licenses and Certifications:
A license in one of the following is required:
  • Licensed Registered Nurse (RN) is required
Technical Skills:
  • Proficient in Microsoft Outlook applications, including MS Word, MS Excel, MS Power Point and MS Outlook is required
  • Healthcare Management Systems (Generic) is required *LI-RG1

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Last Updated On: 12/9/2015