Supervisor of Health Services

WPS Health Solutions New • Madison, WI

1d • $95,000 - $115,000 • Remote

About The Position

Our Health Services Supervisor is responsible for overseeing the Health Services Utilization and Case Management nursing teams . This supervisor will manage inventory, support staff mentoring and training, and drive workflow efficiencies within the teams. Will Work closely with the Health Services Manager, and support implementation of departmental and company initiatives while serving as a key daily resource for the nursing teams. The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, and experience.

Requirements

• Registered Nurse (RN) with current licensure in the state of Wisconsin OR current Compact License.
• Active RN license, applicable to state of practice in good standing.
• Associates Degree in Nursing.
• 5 or more years of clinical experience in a healthcare setting (hospital, clinic, home care, skilled nursing facility, etc.)
• Solid knowledge and understanding of medical/clinical review processes.
• Strong analytical, problem-solving, and organizational skills with the ability to manage multiple cases simultaneously and meet strict deadlines this includes: 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.
• 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

• 1 or more years of experience in a supervisory or leadership role.
• Bachelor’s degree in nursing (BSN).
• Certified Managed Care Nurse (CMCN).
• Health insurance background that could include, Third party Administration (TPA) Point of Service (POS), Preferred Provider Organization (PPO), or Medicare Supplement) plans.

Responsibilities

• Ensure utilization management reviews are completed in accordance with department standards.
• Coaching and mentoring nursing staff conducting medical necessity reviews, prior authorizations, and appeals.
• Overseeing case management activities to ensure timely and appropriate member interventions to meet individual needs and maximize health outcomes.
• Collaborate with physicians, providers, and internal departments to coordinate care for complex cases.
• Monitoring team performance, productivity, quality of care and compliance with established metrics and accreditation standards (e.g., URAC, NCQA).
• Providing training and professional development opportunities for nursing staff.
• Serve as a clinical resource for staff, handling escalated provider and member inquiries.
• Conduct staff quality audits and support the development of clinical guidelines and utilization review protocols.
• Participate in quality improvement initiatives and contribute to the development of department goals and performance targets.
• Assist with system testing, configuration, training, and implementation of new systems or upgrades.

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: Mid Level
• Education Level: Associate degree