The
Manager, Clinical Operations will oversee the team responsible for coordinating and delivering patient progress checks and reviewing clinical documentation for completeness and medical necessity as part of payer programs authorized by their health insurance provider. The team will also review guidelines and provide professional judgment regarding whether or not a member meets the criteria; the nurse team members will also interface with Medical Doctors providing this feedback. Finally, the team members will also participate in patient IDT rounds to gather information. A day in the life!
You will be responsible for the following:
- Directly supervise and manage the performance of Nursing Staff, and other administrative staff, serve as a team communication hub, and track and promote team collaboration and efficiency
- Proactively identify operational challenges and gaps and escalate and provide/maintain visibility to senior leadership to help address gaps and challenges
- Develop and implement teamwork plans; assign work activities; monitor workflow; review and evaluate work product methods and procedures; prioritize and assign work; and communicate regularly with leadership team members
- Provides direction and support to employees to deliver quality services with a focus on organizational success
- Assure all assigned staff receive training and supervision as needed to meet performance expectations.
- Oversee/participate in the hiring process of all assigned positions in accordance with Company policy and local, state, and federal employment law.
- Adheres to the confidentiality of HIPAA-protected health information. Maintains confidentiality of patient information
- Uses data to optimize outcomes and organizational success
- Responsible for the management of KPIs and quality improvement indicators
- Responsible to ensure excellent customer service to patients, referral partners, and others
Do you have what it takes?
Required Qualifications:
- Bachelor's degree in a related field or equivalent work experience
- Minimum 4-6 years of related work experience
- Management experience in a clinical setting
Do you stand above the rest?
Preferred Qualifications:
- Health insurance plan experience
- Utilization Management experience
#LI-AH1#LI-HybridAdditional job expectations applicable to this position include:
- Willingness to work additional or irregular hours as needed
- Working in accordance with corporate and organizational security policies and procedures
- Performing other responsibilities as assigned
WellSky is where independent thinking and collaboration come together to create an authentic culture. We thrive on innovation, inclusiveness, and cohesive perspectives. At WellSky you can make a difference.WellSky provides equal employment opportunities to all people without regard to race, color, national origin, ancestry, citizenship, age, religion, gender, sex, sexual orientation, gender identity, gender expression, marital status, pregnancy, physical or mental disability, protected medical condition, genetic information, military service, veteran status, or any other status or characteristic protected by law.
WellSky is proud to be a drug-free workplace.Applicants for U.S.-based positions with WellSky must be legally authorized to work in the United States. Verification of employment eligibility will be required at the time of hire. Certain client-facing positions may be required to comply with applicable requirements, such as immunizations and occupational health mandates.Here are some of the exciting benefits full-time teammates are eligible to receive at WellSky:
- Excellent medical, dental, and vision benefits
- Mental health benefits through TelaDoc
- Prescription drug coverage
- Generous paid time off, plus 13 paid holidays
- Paid parental leave
- 100% vested 401(K) retirement plans
- Educational assistance up to $2500 per year
