Clinical Medical Management Supervisor (RN) - REMO

at WPS Health Solutions in Marion, Illinois, United States

Job Description


Who We Are
is a leading not-for-profit health insurer in Wisconsin. Our services offer health insurance plans for individuals, families, seniors, and group plans for small to large businesses. We process claims and provide customer service support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad. In 2021, WPS Health Solutions celebrated of making health insurance easier for those we serve. Proud to be military and veteran ready.
Our Culture
WPS' Performance-Based Culture is where the great work and innovations of our people are seen, fueled, and rewarded. We accomplish this by creating an inclusive, empowering employee experience, focusing on People, Work, and Conditions. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities. We are guided by our Purpose: Together, making health care easier for the people we serve.
In 2021 and 2022, WPS Health Solutions was recognized for several awards including:


Role Snapshot
The Clinical Supervisor (RN) will oversee a team of 6 to 15 remote Medical Review Senior Nurse Analysts that complete Targeted Probe & Educate (TPE) work for our Medicare contract. The primary purpose of this leadership role is to provide coaching to team members on the delivery and effectiveness of education and training provided and the outcome of quality analysis reviews. This role will also be responsible for serving as a main resource for claim review decision making when there is a need for regulation interpretation. This role contributes to WPS by ensuring that we meet program requirements for the Centers for Medicare & Medicaid Services (CMS) TPE program.
In this role you will:
Coach team members on effective training
Serve as a resource for understanding coverage guidelines by researching and making decisions in ambiguous situations
Collaborate with other Clinical Supervisors on education planning
How do I know this opportunity is right for me? If you:
Enjoy leading and helping teams grow
Are strong at making decisions independently without guidance
Enjoy researching guidelines
Are looking to move away from direct patient care and want to use your nursing knowledge in a new and different way
Are technically strong on computers
Desire day hours with no on-call work, limited weekend work, and holidays off
Are process improvement minded and actively seek out ways to work smarter, not harder
What will I gain from this role?
Collaborating with a team of both clinicians and non-clinicians
Better understanding how government contractors, like WPS Health Solutions, serve our Medicare beneficiaries
Learning about our Hyland OnBase tool which is our content management system used for viewing electronic records
Enjoying a work from home position with daytime hours, no on-call work, no travel, and holidays off
Minimum Qualifications
Bachelor's degree in related field or equivalent post high school and/or related work experience
1 or more years of related work and/or leadership experience
Active RN license, applicable to state of practice
Preferred Qualifications
A minimum of 4 or more years of experience in clinical nursing
Experience leading a team of 10 or more members successfully either in-person or remotely
Background in Medicare principles and guidelines
Strong computer skills including:
Ability to utilize multiple screens and learn new applications with ease
Intermediate knowledge in MS Word and MS Excel (creating, sorting, and filtering spreadsheets)
Salary Range
The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills and experience.
This role is open to 100% remote work for this opportunity in the following approved states:
Arizona, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Jersey, North Carolina, North Dakota, Ohio, South Carolina, South Dakota, Texas, Virginia, Wisconsin
Minimal to no travel. Employee may be expected to travel to 1 CMS conference and 1 department management meeting at most per year
Remote Worker Requirements
For remote position, employee is required to meet remote worker requirements, including a designated work station, a wired (Ethernet) connection to the network, and a minimum of 10Mbps downstream connection with at least 1Mbps upstream (can be checked at )
The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills and experience.
Remote work option available
Performance bonus and/or merit... For full info follow application link.

Wisconsin Physicians Service Insurance Corporation is an Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities employer.

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Job Posting: 10983672

Posted On: Jun 03, 2023

Updated On: Jul 01, 2023

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