Clinical Manager

WPS Health Solutions New • Madison, WI

22h • $100,000 - $120,000 • Hybrid

About The Position

Our Clinical Manager is accountable to plan, organize, manage, and evaluate clinical operations for Medical Review. This includes developing Centers for Medicare & Medicaid Services (CMS) reports as well as managing activities to ensure accurate rendering of claim decisions. They collaborate with other business areas to ensure WPS and CMS goals and objectives are met utilizing cost-effective, timely, accurate, and innovative methods. This Clinical Manager is accountable to ensure compliance with regulatory and payor guidelines. Salary Range $100,000 ~ $120,000 The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, and experience. Work Location: Remote OR Hybrid We are open to remote work in the following approved states: Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, Ohio, South Carolina, Texas, Virginia, Wisconsin Employees living within 45 miles of WPS Headquarters ( 1717 W. Broadway in Madison, WI) will be expected to be able to come into the office 2 days a week on a regular basis. How do I know this opportunity is right for me? If you: Can develop, implement, and maintain the Improper Payment Reduction Strategy (IPRS) for Medical Review. Enjoy leading people monitoring and maintaining Full Time Equivalents (FTEs), budget, and workload according to IPRS. Thrive when ensuring accurate and timely handling of Medical Review clinical decisions. Can monitor all results for Medical Review Accuracy Award Fee, providing follow-up, dispute, and education as indicated. Have coordinate with the Medical Review Operations Manager in preparation of the Monthly Status Report. Want to ensure effective and timely response to clinical concerns raised by CMS, other CMS contractors and other clinical areas. Can maintain detailed knowledge of all Medicare regulations and broad level knowledge of WPS business capabilities. Have ensured compliance within federal and state regulations, CMS guidelines, and company policies. Enjoy coaching and mentoring the Clinical Med Management team to ensure a culture of accountability and excellence; execute programs to drive employee engagement and satisfaction.

Requirements

• Associate’s (ASN) or Bachelor’s Degree in Nursing (BSN).
• Active RN license, applicable to state of practice in good standing.
• 5 or more years of clinical experience in a healthcare setting (hospital, homecare, skilled nursing, etc.)
• 3 or more years in a leadership role.
• Extensive knowledge and understanding of CMS guidelines and regulations.
• Extensive knowledge and understanding of medical/clinical review processes.
• Strong analytical, problem-solving, and organizational skills that include: The ability to manage multiple cases simultaneously and meet strict deadlines.
• Excellent reading comprehension, written and verbal communication skills, with the ability to communicate complex medical information clearly and concisely.
• Proficient in Microsoft Office tools with experience working in electronic health records.
• Wired (ethernet cable) internet connection from your router to your computer
• High speed cable or fiber internet
• Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at https://speedtest.net )

Nice To Haves

• Experience working for a Medicare Administrative Contractor (MAC).

Responsibilities

• Plan, organize, manage, and evaluate clinical operations for Medical Review.
• Develop Centers for Medicare & Medicaid Services (CMS) reports.
• Manage activities to ensure accurate rendering of claim decisions.
• Collaborate with other business areas to ensure WPS and CMS goals and objectives are met utilizing cost-effective, timely, accurate, and innovative methods.
• Ensure compliance with regulatory and payor guidelines.
• Develop, implement, and maintain the Improper Payment Reduction Strategy (IPRS) for Medical Review.
• Lead people monitoring and maintaining Full Time Equivalents (FTEs), budget, and workload according to IPRS.
• Ensure accurate and timely handling of Medical Review clinical decisions.
• Monitor all results for Medical Review Accuracy Award Fee, providing follow-up, dispute, and education as indicated.
• Coordinate with the Medical Review Operations Manager in preparation of the Monthly Status Report.
• Ensure effective and timely response to clinical concerns raised by CMS, other CMS contractors and other clinical areas.
• Maintain detailed knowledge of all Medicare regulations and broad level knowledge of WPS business capabilities.
• Ensure compliance within federal and state regulations, CMS guidelines, and company policies.
• Coach and mentor the Clinical Med Management team to ensure a culture of accountability and excellence; execute programs to drive employee engagement and satisfaction.

Benefits

• Remote and hybrid work options available
• Performance bonus and/or merit increase opportunities
• 401(k) with a 100% match for the first 3% of your salary and a 50% match for the next 2% of your salary ( 100% vested immediately )
• Competitive paid time off
• Health insurance, dental insurance, and telehealth services start DAY 1
• Professional and Leadership Development Programs

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: Associate degree