Sr. Team Lead, Clinical Operations

WellSky

1d

About The Position

The Sr. Team Lead, Clinical Operations is responsible for overseeing the team responsible for coordinating and delivering care to patients as part of payer programs authorized by their health insurance provider. The scope of this job includes providing operational and management oversight a team of clinicians and other members of the clinical team but does not include providing clinical oversight to staff. This position oversees a team of Utilization Review Clinicians who are responsible for timely review of request for post-acute services based on established clinical guidelines and/or coverage benefits limitations to determine appropriateness of requested services. Alongside their team, the Sr. Team Lead, Clinical Operations will develop relationships with physicians, healthcare service providers, and internal and external clients to help improve health outcomes for enrollees. They will apply clinical knowledge to work with facilities and providers for care coordination and comply with all standard operating procedures, as well as departmental and organizational policies. They will access and consult with peer clinical reviewers, Medical Directors, and/or delegated clinical reviewers to help ensure medically appropriate, quality, and cost-effective care throughout the medical management process. The ideal candidate will possess a passion for coaching and mentoring others, as well as working knowledge and aptitude of the Microsoft suite of applications (e.g., Office, Excel), clinical decision support tools and operational software. We invite you to apply today and join us in shaping the future of healthcare!

Requirements

• Bachelor's Degree or equivalent work experience
• 4-6 years of clinical nursing or therapy experience
• Active RN license
• Able to pass federal and state required background checks and drug screen
• Willing to travel up to 30% based on business needs.
• Willing to work additional or irregular hours as needed.
• Must work in accordance with applicable security policies and procedures to safeguard company and client information.
• Must be able to sit and view a computer screen for extended periods of time.

Nice To Haves

• 1-2 years' experience in utilization review, case management and/or managed care regulations
• Experience with MCG (Milliman Care Guidelines), InterQual or other clinical decision support tools, especially in utilization management and prior authorization processes
• General understanding of managed care guidelines and impact on services

Responsibilities

• Oversee daily operations of clinical operation support staff and ensure tasks are completed efficiently and accurately.
• Identify and address operational challenges and escalate more complex issues to management as needed.
• Support the development and implementation of work plans, assign tasks, and ensure alignment with program objectives.
• Manage larger, more-complex and growing or expanded clinical programs.
• Provide enhanced training and mentorship to team members by fostering skill development and professional growth.
• Collaborate with managers on recruitment, onboarding, and performance feedback for team members.
• Analyze team performance data and recommend process improvements to enhance quality, efficiency, and service outcomes.
• Perform other job duties as assigned.

Benefits

• Excellent medical with Rx, dental, and vision benefits
• Mental Health support through EAP
• Generous paid time off, plus 13 paid holidays
• 100% vested 401(K) retirement plans
• Educational assistance up to $2500 per year

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level