Clinical Medical Management Supervisor

WPS Health Solutions
dental insurance, paid time off, 401(k), remote work
United States, Nevada, Las Vegas
Jan 10, 2025
Description Role Snapshot The Clinical Supervisor (RN) will oversee a team of 15-25 remote Medical Review Nurse Analysts that complete Prior Authorization (PA) work for our Medicare contract. The primary purpose of this leadership role is to provide coaching to team members on production of work, quality of their reviews and education delivery to providers. This role contributes to WPS by ensuring that we meet program requirements for the Centers for Medicare & Medicaid Services (CMS) PA program. In this role you will: Monitor team and individual quality and quantity metrics Coach and train team members Ensure proper workload distribution and timely completion Collaborate with other Clinical Supervisors on education planning Salary Range $75,000-90,000 The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, and experience. How do I know this opportunity is right for me? If you: Enjoy leading and helping teams grow Are strong at making decisions independently without guidance Are looking to move away from direct patient care and want to use your nursing knowledge in a new and different way Are technically strong on computers Desire day hours with no on-call work, limited weekend work, and holidays off Are process improvement minded and actively seek out ways to work smarter, not harder What will I gain from this role? Collaborating with a team of both clinicians and non-clinicians Better understanding how government contractors, like WPS Health Solutions, serve our Medicare beneficiaries Learning about our Hyland OnBase tool which is our content management system used for viewing electronic records Enjoying a work from home position with daytime hours, no on-call work, no travel, and holidays off Minimum Qualifications Bachelor's degree in related field or equivalent post high school and/or related work experience 1 or more years of related work and/or leadership experience Active RN license, applicable to state of practice Preferred Qualifications A minimum of 4 or more years of experience in clinical nursing Experience leading a team of 10 or more members successfully either in-person or remotely Background in Medicare principles and guidelines Strong computer skills including: Ability to utilize multiple screens and learn new applications with ease Intermediate knowledge in MS Word and MS Excel (creating, sorting, and filtering spreadsheets) Remote Work Requirements Wired (ethernet cable) internet connection from your router to your computer High speed cable or fiber internet Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at https://speedtest.net) Please review Remote Worker FAQs for additional information Work Location This role may require some work out of our Madison, WI headquarters. Individuals that are located within 45 miles of our corporate headquarters will have opportunities to come into the office on a regular cadence. This role is also open to 100% remote work for this opportunity in the following approved states: Arizona, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Jersey, North Carolina, North Dakota, Ohio, South Carolina, South Dakota, Texas, Virginia, Wisconsin We are a remote-first organization and offer remote work in the following approved states: Arizona, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Jersey, North Carolina, North Dakota, Ohio, South Carolina, South Dakota, Texas, Virginia, Wisconsin Hybrid Work Location This position will be hybrid, having the regional availability to come in our Office on a day or two a week cadence. Our office location: WPS Corporate Center Building - 1717 W. Broadway in Madison, WI. Onsite work will be tailored for team cohesion, strategy, planning and collaboration. Benefits Remote and hybrid work options available Performance bonus and/or merit increase opportunities 401(k) with a 100% match for the first 3% of your salary and a 50% match for the next 2% of your salary (100% vested immediately) Competitive paid time off Health insurance, dental insurance, and telehealth services start DAY 1 Employee Resource Groups Professional and Leadership Development Programs Review additional benefits: (https://www.wpshealthsolutions.com/careers/fulltime_benefits.shtml) Who We Are WPS Health Solutions is a leading not-for-profit health insurer and federal government contractor headquartered in Wisconsin. WPS offers health insurance plans for individuals, families, seniors, and group health plans for small to large businesses. We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad. WPS Health Solutions has been making health care easier for the people we serve for more than 75 years. Proud to be military and veteran ready. Culture Drives Our Success WPS' Culture is where the great work and innovations of our people are seen, fueled, and rewarded. We accomplish this by creating an inclusive and empowering employee experience. We recognize the benefits of Diversity, Equity, and Inclusion as an investment in our workforce-both current and future-to effectively seek, leverage, and include diverse perspectives that fuel agility and innovation on high-performing teams. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities. We are proud of the recognition we have received from local and national organization regarding our culture and workplace: WPS Newsroom - Awards and Recognition Sign up for Job Alerts FOLLOW US! Instagram LinkedIn Facebook WPS Health Blog Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)