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Supv, Clinical Care at WellCare

Posted in Health Care 30+ days ago.

This job brought to you by eQuest

Type: Full-Time
Location: Tampa, Florida





Job Description:

Supv, Clinical Care

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

Reports to: Charlotte Chovanec

Department: Health Services

Position Location: Tampa, FL 33634

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.
Additional Responsibilities:

    Candidate Education:


    • Required A High School or GED

    • Preferred A Bachelor's Degree in a related field
    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

    • Intermediate Ability to effectively present information and respond to questions from families, members, and providers

    • Intermediate Ability to work within tight timeframe's 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 families, members, and providers

    • Intermediate Ability to effectively present information and respond to questions from peers and management

    • Intermediate Other 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 Other Knowledge of utilization management principles and criteria sets

    • Intermediate Other 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)
    Technical Skills:


    • Required Intermediate Microsoft Excel

    • Required Intermediate Microsoft Word

    • Required Intermediate Microsoft Outlook

    • Required Intermediate Microsoft PowerPoint

    • Required Intermediate Healthcare Management Systems (Generic)
    Languages: