Supervisor, Clinical Review Nurse

  • 16945 Northchase Dr, Houston, TX 77060, USA
  • Employees can work remotely
  • Full-time

Company Description

HealthHelp - A WNS Company (www.HealthHelp.com), is the leader in the field of healthcare utilization & care management. We have gained this position by actively working to change out-of-date practices with a collaborative, non-denial based approach. Our methodology helps payors achieve a higher return on investment, gives providers education programs that better inform physicians, and ensures quality and safety for the patients needing treatment.

HealthHelp’s innovative approach and strong IT capability in specialty benefits management means that staff will move healthcare forward when provided with evidence-based solutions and second opinions. HealthHelp's staff is comprised of healthcare professionals who make a difference every day. HealthHelp has a desire to fill their company with talented and innovative people who want a career path filled with success and personal growth.

Our specialty benefits management services are broad and include, Cardiology, Oncology, Radiology, Radiation Therapy, Sleep Care, and Musculoskeletal Care. HealthHelp has two locations in Houston, one a corporate office and the second a state-of-the art contact center. HealthHelp is also proud to have another such contact center in Albany, New York.

WNS Global Services Inc. (NYSE: WNS) is a global Business Process Management (BPM) leader. WNS offers business value to 400+global clients by combining operational excellence with deep domain expertise in key industry verticals, including Banking and Financial Services, Consulting and Professional Services, Healthcare, Insurance, Manufacturing, Retail and Consumer Packaged Goods, Shipping and Logistics, Telecommunications, Travel and Utilities. Globally, the group’s over 44,000+ Professionals serve across 60 delivery centers in 16 countries worldwide.

Job Description

Essential Duties:

·         Supervises a team of clinical staff with varying professional license and education levels

·         Conducts formal performance appraisals according to pre-determined performance metrics and measures of success and documents reviews and recommendations per HR policy at 90 days for newly hired staff, and annually for all direct reports

·         Handles and reviews disciplinary actions directly with employees, i.e., verbal warnings, records of discussion, and formal disciplinary documentation.

·         Enables team members to ensure consistent quality service to clients, providers and members

·         Continuously tracks and monitors program/client, team, and individual performance metrics and  provides feedback and coaching to ensure performance goals are achieved

·         Conducts formal Team and individual staff meetings to disseminate information

·         Serves as an additional training resource to improve effectiveness of the clinical assessment process in relation to new program updates and process changes.

·         Oversees and evaluates staff work assignments and makes appropriate adjustments to ensure case-specific turnaround times (TAT) related to client service level agreements and regulatory compliance requirements are met for their specified program(s)

·         Partners with Workforce Planning to ensure appropriate resources are allocated to meet workload demand

·         Addresses escalated procedural and technical issues and coordinates with the appropriate departments to effectively resolve the issue(s)

·         Coordinates with Programs and Client Services to ensure appropriate business processes are being followed and enhancements are being developed and implemented

·         Identifies issues related to specific programs and makes suggestions for improving effectiveness and efficiency

·         Acts as first level liaison for escalated Client Service issues and actively determines best resolution

STANDARD DEPARTMENTAL RESPONSIBILITIES:

·          Develop, implement, and utilize a multifaceted rewards system that makes team members excited to show up to work every day and do their best

·          Use empowerment, trust and other strategies as appropriate to develop and motivate team members

·          Facilitate a healthy and motivating work environment and atmosphere

·          Creates, encourages, and supports an environment that fosters teamwork, respect, diversity, and cooperation with others

·          Utilizes knowledge of telephony, ACD, workforce, and related systems to manage daily phone metrics

·          Responsible for knowing the intricacies of all benefit management programs including applicable regulatory compliance, accreditation standards, and client/health plan service level requirements for each program, line of business, and geographic region

·          Collaborates with human resources to ensure adherence to company policies

·          Refers all complaints to director of corporate compliance, works collaboratively with the compliance department to investigate complaints and correct errors

·          Assists with service restoration efforts during emergencies

·          Accurately answers questions regarding Plan benefits for members and providers

·          Promotes business focus which demonstrates an understanding to the company’s vision, mission, and strategy

·          Utilizes knowledge of telephony, ACD, workforce, and related systems to manage daily phone metrics

·          Performs other related duties and projects as assigned

·          Adheres to all HIPAA, state and federal regulations pertaining to the clinical programs

·          Adheres to both URAC & NCQA standards pertinent to their job description

Qualifications

QUALIFICATIONS:

·          Current active unrestricted RN or LVN/LPN license in a state or territory of the United States required

·          Minimum 3 years’ experience in UM/QM acute care or managed care setting required

·          Minimum 2 years of progressively responsible supervisory experience in a managed care environment preferred

·          Excellent interpersonal, written and presentation skills, including the ability to handle interactions with facility personnel, providers, members and various internal departments in a professional manner

·          Proficient leadership and facilitation skills

·          Ability to work in a fast-paced, evolving environment, on-call after hours work may be required

·          Excellent organizational skills

·          Highly motivated, self-starter who works independently using all available resources, policies, and procedures to work effectively and meet deadlines in an atmosphere of multiple projects and shifting priorities

·          Demonstrated knowledge and experience in using critical thinking skills

Additional Information

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