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Health Services
WellCare - Nursing Careers

Supervisor - Clinical Care RN Job

Full Job Title: Supervisor, Clinical Care RN (Utilization Management)*

Job Number: 1703710

Location: Springfield, IL

Date Posted: 10-2-2017

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

DEPARTMENT: Health Services-Utilization Management

REPORTS TO: Director, Utilization Management

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.

*LI-SM1

Candidate Education:
  • Required A High School or GED
  • Required a Bachelor's Degree in nursing
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 knowledge of community, state and federal laws and resources
  • Intermediate
  • 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 peers and management
  • Intermediate 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 knowledge of utilization management principles and criteria sets
  • Intermediate 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), no restrictions
Technical Skills:
  • Required intermediate Microsoft Excel, Word, Power Point and Outlook
  • Required intermediate to use proprietary health care management system
  • Required Intermediate Healthcare Management Systems (Generic)

Languages:

  • Bilingual helpful

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Last Updated On: 12/9/2015