Supervisor – Clinical Operations, Nurse

Clinical OperationsClinical OperationsFull TimeRemoteJuniorTeam 1,001-5,000Since 1937H1B No SponsorCompany SiteLinkedIn

Location

California + 10 moreAll locations: California | Colorado | Connecticut | Maine | Montana | New York | Oregon | Pennsylvania | Vermont | Washington | Wyoming

Posted

2 days ago

Salary

$92.7K - $117.2K / year

Seniority

Junior

Bachelor Degree1 yr expEnglish

Job Description

Supervisor – Clinical Operations, Nurse

GEHA Health

• Owns and oversees day-to-day process across the organization for their specific workstream, and ensures staff compliance with program workflows, clinical documentation, benefit resource allocation, and work distribution. • Responsible for oversight of complex or escalated case investigations and notifies department leadership as appropriate. • Coordinates department workload and identifies staffing needs or other resources to meet quality, quantity, and departmental goals. • Communicates changes in departmental processes and procedures to staff when necessary. • Serves as primary contact for staff, assigned internal and external programs and escalated issues. • Identifies potential process improvement opportunities across departments and makes recommendations to leadership as appropriate. • Audits staff processes and reviews cases with staff to assess compliance with established clinical and clinical support guidelines, workflows, and adherence to benefits structure and applicable regulations. • Consults with the leadership regarding complex and/or high-profile cases. • Recommends promotion, termination, hiring or reassignment of subordinates including scheduling and conducting informal and formal employee performance reviews, coaching and competency assessments. • Leads performance management, coaching, and talent development to build a high‑performing, engaged team. • Reviews performance issues with leadership and makes recommendations regarding level of discipline including developing performance improvement plans and delivering disciplinary action after reviewing with leadership and Human Resources. • Develops, implements, and maintains internal policies and procedures. • Coordinates department project planning to accommodate the company's annual business needs. • Works with management team to develop future programs and goals. • Collaborates with clinical staff and Medical Director regarding medical cases to ensure services are clinically appropriate. • Assists with development of department training materials. • Identifies educational opportunities for the staff. • Collaborates with Clinical Operations Division educator to provide educational opportunities. • Uses performance metrics and data analysis to identify trends, drive continuous improvement, and improve outcomes.

Job Requirements

  • Requires a bachelor’s degree in clinical field for which the team has responsibility (Example: Nursing teams would need a BSN)
  • Associates degree in a related health field may be considered with 5 years of experience
  • Active/Good standing RN license, including accountability for maintaining all requirements of licensing post hire, must be eligible to be licensed in all US states and territories
  • 1-3 years leadership experience
  • Demonstrates excellent verbal and written communications skills
  • Shows strong collaboration skills and the ability to build productive working relationships
  • Displays a high level of self-initiative and independent problem-solving skills.
  • Preferred: Nursing experience in Fertility, Obstetrics, Labor, and Postpartum care.
  • Case Management experience is preferred
  • Must have the ability to provide a non-cellular High Speed Internet Service such as Fiber, DSL, or cable Modems for a home office. A minimum standard speed for optimal performance of 30x5 (30mpbs download x 5mpbs upload) is required.
  • Latency (ping) response time lower than 80 ms
  • Hotspots, satellite and wireless internet service is NOT allowed for this role.
  • A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Benefits

  • Health/Vision/Dental benefits effective day one
  • 401(k) retirement plan: company match – dollar for dollar up to 4% employee contribution (pretax or Roth options) plus a 6% annual company contribution
  • Robust employee well-being program
  • Paid Time Off
  • Personal Community Enrichment Time
  • Company-provided Basic Life and AD&D
  • Company-provided Short-Term & Long-Term Disability
  • Tuition Assistance Program

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