The Supervisor, Clinical is responsible for the day-to-day supervision of clinical staff. These supervisory functions are divided into 2 separate areas of supervisory responsibility:
- Pre-Certification and Provider Call Center
- Inpatient and Skilled Nursing Facility Concurrent Review
ESSENTIAL DUTIES AND RESPONSIBILITIES:
QUALIFICATIONS AND REQUIREMENTS : To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Supervises assigned team, including but not limited to the following responsibilities: interviews, assists in selection, and trains employees; provides on-going coaching, mentoring, and development of employees, fostering an atmosphere of teamwork; assists in the establishment of performance goals with employees and monitors progress with regard to achievement of those goals; plans, schedules and directs the work of employees; assists in the evaluation of employees’ performance and productivity; takes disciplinary actions with employees as needed; addresses employee complaints and grievances; makes effective recommendations with regard to the hiring, firing, promotion and other status changes, and pay rates of employees.
- Works in conjunction with the Manager, Utilization Management to establish department goals and objectives as they relate to productivity and compliance requirements.
- Supervises daily processes through review of daily reports
- Assists in the development of policies, procedures and processes.
- Supervises all department report requirements in conjunction with the Manager, Utilization Management.
- Supervises the denial process to ensure that regulatory requirements are followed; ensures all QIO requests are coordinated and completed per regulations
- Other duties as assigned.
EDUCATION and/or EXPERIENCE: Florida licensed LPN or RN required; an Associate’s degree from an accredited institution of higher learning preferred; minimum of three years of related Medicare/Medicaid HMO experience required, preferably at the supervisory level.
For the area of Pre-Certification and Provider Call Center:
For the area of Inpatient and Skilled Nursing Concurrent Review:
- Working knowledge of telephony call center statistics
- Strong knowledge base of Medicare and Medicaid coverage criteria and compliance requirements
NECESSARY KNOWLEDGE, SKILLS AND ABILITIES: Knowledge of Medicare preferred. Ability to read and interpret documents, ability to calculate figures and amounts, excellent communication skills, good grammar, voice and diction, proficient in MS Office, basic computer and keyboarding skills, excellent customer service skills (friendly, courteous and helpful). Ability to develop a capable, cohesive and harmonious working team that strives for excellence in quality of all services provided.
- Experience in discharge planning from Inpatient Acute Care Facilities to other levels of post inpatient care
- Strong understanding and implementation of Medicare criteria as it relates to Skilled Nursing Facility care.
LICENSING AND CERTIFICATION: Florida licensed RN or LPN required.
PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to sit. The employee frequently is required to use hands 10 finger, handle, or feel objects, tools, or controls and talk or hear.
Specific vision abilities required to this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.
WORK ENVIRONMENT : The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The noise level in the work environment is usually moderate.
For the most part ambient room temperatures, lighting and traditional office equipment as found in a typical office environment.
ADDITIONAL INFORMATION: The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
The duties listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment to the position.
We are proud to be an EEO/AA employer M/F/D/V. We maintain a drug-free workplace and perform pre-employment substance abuse testing.