Supervisor, Clinical Ops

Role Overview

• Manages, analyzes and coordinates the daily activities of the unit to ensure departmental productive goals are met with regards to quality timeliness, accuracy and consistency of medical decisions.
• Ensures staff meets all regulatory requirements and comprehends and complies with best practices, professional standards, internal policies and procedures.
• Conducts continuous evaluation of workflows and seeks to improve processes that impact the department.
• Coordinates data collection, reviews compliance reporting and identifies opportunities for improvements.
• Identifies and implements cost saving/revenue generating opportunities.
• Serves as key liaison between Medical Directors, Management leadership, and staff.
• Also serves as a medical resource to members and providers, as well as non-clinical staff.
• Develops key performance indicators to evaluate level of service for internal and external customers.
• Acts as a subject matter expert for difficult and complex matters.
• Represents the Plan with external customers, providers and agencies.
• Represents the department on internal committees and participates in special projects.
• Assists Manager in coordinating regulatory, quality and accreditation activities.
• Performs other duties as assigned by management.
• Creates and champions an atmosphere within the team, which fosters open communication, teamwork, ownership, and a collaborative cross-departmental environment to implement, optimize and share continuous improvement processes.
• Manages, directs, and develops staff by providing feedback and coaching.
• Administers performance and salary reviews for staff.
• Ensures staff meets all regulatory requirements and comprehends and complies with best practice methodology, professional standards, and internal policies and procedures.
• Assists in preparing and monitoring the budget to ensure administrative cost objectives are met.

Requirements

• Requires a Nursing degree or a Masters in a Behavioral health related field or a Bachelors in a health related field.
• Requires a minimum of two years' full time acute healthcare/direct clinical care experience to the consumer.
• Requires a minimum of one year direct supervisory experience or demonstrated supervisory experience leading teams in a matrix management environment.
• Prefer certification as a case manager.
• Prefer minimum of three years’ experience as a case manager.
• Requires minimum of 12 months experience in a managed care setting or the health insurance industry.
• Active Unrestricted NJ LCSW, LMFT, LPC, or RN/PT License Required.
• Medicaid Case Management Only: Active Unrestricted NJ LSW, LCSW, LMFT, LPC, or RN/PT License Required.
• Requires knowledge of Utilization Management (UM) and managed care principles.
• Requires knowledge of the Case Management/Disease Management Standards of Practice.
• Requires knowledge of health care systems and medical documentation.
• Requires knowledge of State Mandates and Regulations.
• Requires knowledge of regulatory bodies and their processes.
• Requires knowledge of NCQA accreditation standards.
• Requires knowledge of community health resources.

Benefits

• Comprehensive health benefits (Medical/Dental/Vision)
• Retirement Plans
• Generous PTO
• Incentive Plans
• Wellness Programs
• Paid Volunteer Time Off
• Tuition Reimbursement