Supv - Non-Clinical Operations

Summary

Responsible for supervising the daily operations of Clinical Quality member outreach programs and processes. Serves as the primary contact for staff, assigned to internal and external programs, and escalated management issues. Assists Administrator / Manager with developing Clinical Quality utilization policies and procedures. Monitors internal and external policies and workflow for compliance in regard to departmental goals. Provides support and supervision to department staff. Works under the direct supervision of the Clinical Quality Administrator / Manager.

Duties

• Supervises the Clinical Quality staff, as assigned. Serves as a resource for all team staff regarding program workflows, clinical documentation, claims processing system issues, and work distribution.
• 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 care management issues. Tracks and trends performance of assigned staff, using department metrics. Assists clinical and clinical support team with complex or escalated cases and notifies department Administrator or Manager as appropriate.
• Recommends promotion, termination, hiring or reassignment of subordinates including scheduling and conducting informal and formal employee performance reviews. Maintains attendance records and approves leave requests.
• Reviews performance issues with Administrator / Manager and makes recommendation regarding level of discipline. Develops communication form, action plan, and delivers disciplinary action after reviewing with the Administrator / Manager.
• Communicates outside the department to other Supervisors, Assistant Supervisors, and leads regarding specific member claim issues. Identifies potential process improvement opportunities across departments and makes recommendations to Administrators / Managers as appropriate.
• Audits staff processes and reviews cases with staff to assess compliance with established clinical support guidelines, workflows, and adherence to benefits structure and member progress towards goals. Consults with the Clinical Quality Administrator / Manager regarding complex and / or high-profile cases.
• Produces routine and ad hoc reports to track staff productivity and program measures of success. Reviews reports, identifies issues and trends, and makes recommendations to Administrator / Manager.
• Assists with development of Clinical Quality training materials. Identifies educational opportunities for the staff. Informs and collaborates with department educator to provide on-site educational opportunities.
• Responsible for the development, implementation, and maintenance of Clinical Quality policies and procedures. Collaborates with Administrator / Manager in creating, updating, and revising policies and workflows.
• Coordinates department project planning to accommodate the company's annual business needs. Works with management team to develop future programs and goals.