Clinical Medical Management Supervisor (RN) - REMOTE

DescriptionWho We AreWPS Health Solutions (https://www.wpshealthsolutions.com/about/index.shtml) is a leading not-for-profit health insurer in Wisconsin. Our services offer health insurance plans for individuals, families, seniors, and group plans for small to large businesses. We process claims and provide customer service 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. In 2021, WPS Health Solutions celebrated 75 years (https://www.wpshealthsolutions.com/75/) of making health insurance easier for those we serve. Proud to be military and veteran ready. Our CultureWPS’ Performance-Based Culture is where the great work and innovations of our people are seen, fueled, and rewarded. We accomplish this by creating an inclusive, empowering employee experience, focusing on People, Work, and Conditions. 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 guided by our Purpose: Together, making health care easier for the people we serve. In 2021 and 2022, WPS Health Solutions was recognized for several awards including:

Madison, Wisconsin’s Top Workplaces (https://www.wpshealthsolutions.com/careers/)

Top Workplace national cultural excellence awards for Remote Work and Work-Life Flexibility

Achievers 50 Most Engaged Workplaces® with the further honor of Achievers “Elite 8” winner in the category of Culture Alignment (https://www.wpshealthsolutions.com/careers/)

Role SnapshotThe Clinical Supervisor (RN) will oversee a team of 6 to 15 remote Medical Review Senior Nurse Analysts that complete Targeted Probe & Educate (TPE) work for our Medicare contract. The primary purpose of this leadership role is to provide coaching to team members on the delivery and effectiveness of education and training provided and the outcome of quality analysis reviews. This role will also be responsible for serving as a main resource for claim review decision making when there is a need for regulation interpretation. This role contributes to WPS by ensuring that we meet program requirements for the Centers for Medicare & Medicaid Services (CMS) TPE program. In this role you will:

Coach team members on effective training

Serve as a resource for understanding coverage guidelines by researching and making decisions in ambiguous situations

Collaborate with other Clinical Supervisors on education planning

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

Enjoy researching guidelines

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)

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.

Location

This role is 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

Travel

Minimal to no travel. Employee may be expected to travel to 1 CMS conference and 1 department management meeting at most per year

Remote Worker Requirements

For remote position, employee is required to meet remote worker requirements, including a designated work station, a wired (Ethernet) connection to the network, and a minimum of 10Mbps downstream connection with at least 1Mbps upstream (can be checked at https://speedtest.net)

Benefits

The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills and experience.

Remote work option available

Performance bonus and/or merit increase opportunities

401(k) with dollar-per-dollar match up to 6% of salary (100% vested immediately)

Competitive paid time off

Health, dental insurance, Teladoc starts DAY 1

Review additional benefits here (https://www.wpshealthsolutions.com/careers/fulltimebenefits.shtml)

Sign up for Job AlertsFOLLOW US!LinkedIn (https://www.linkedin.com/company/wps-health-solutions/) FacebookTwitter (https://twitter.com/WPSHS) Equal Opportunity Employer/Protected Veterans/Individuals with DisabilitiesThe 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)