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Manager, Clinical Review in Bloomington at KEPRO

Date Posted: 9/6/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    Bloomington
  • Job Type:
  • Experience:
    At least 5 year(s)
  • Date Posted:
    9/6/2018

Job Description

Since 1985, KEPRO has helped more than 20 million members lead healthier lives through clinical expertise, integrity and compassion. KEPRO was founded by physicians and clinical expertise is at the core of our organization. We are a leading quality improvement and care management organization. We offer innovative and outcomes-focused solutions to reduce the unnecessary use of health care resources and optimize the quality of care for public and commercial clients. KEPRO’s tailored programs maximize members’ quality of life, and realize greater cost savings for members and clients alike. KEPRO is on a journey to transform medical management and to develop customized solutions tailored to our client’s specific business requirements, while improving the quality of life for patients, reducing costs, and achieving return on investments for our clients. Our approach to medical management is holistic and compassionate and is coordinated around a patient’s entire healthcare experience.

Manager, Clinical Review

Summary Description 

Responsible for the management and oversight of Review Operations activities within clinical, contractual, and budgetary parameters. 

 Accountabilities / Essential Functions

  • Advises and manages direct reports relative to their responsibilities for Review Operations including but not limited to operational standards, policy and procedures, quality monitoring, and educational needs.
  • Assures timely completion of all Review Operations related contract deliverables.
  • Ensures that associated physician review activities are performed timely.
  • Prepares and submits required reports on a timely basis.
  • Assists in achieving annual organizational priorities and operational indicators.
  • Functions as contract/provider liaison and contact/resource person for customer service issues and problem resolutions; functions as a liaison for internal customers.
  • Foster and maintain strong communications links with internal and external customers through various means; e.g., one-on-one meetings, team meetings, and interdepartmental meetings.
  • Provides oversight of Review Operations activities including processes, staff development, internal training, external training (providers) where required, the quality of the review processes, and deliverables.
  • Ensures accountability of qualified nurses to organizational decisions affecting consumers.
  • Other duties as assigned

 The list of accountabilities is not intended to be all-inclusive and may be expanded to include other education- and experience-related duties that management may deem necessary from time to time.

 Qualifications 

  • Active RN licensure required.
  • Bachelor’s Degree or equivalent directly applicable experience in nursing, healthcare administration or related area is preferred.

Skills, Knowledge Abilities (SKA)             

  • Excellent verbal and written communication skills essential.
  • Customer-focused, results-oriented and capable of building and maintaining relationships with internal and external customers. 
  • Knowledge of CQI tools preferred.
  • Organizational skills, ability to plan and prioritize multiple assignments essential.
  • Computer proficiency in Microsoft Office applications and other software programs preferred.
  • Ability to work within KEPRO’s decision-making and organizational structure.
  • Skill in examining and re-examining operations and procedures, formulating policy, and developing and implementing new strategies and procedures.
  • Knowledge of U.S. healthcare industry; preferably with experience in both public and private sector. 
  • Demonstrated expertise in managing differing customer needs.
  • Ability to participate as a team member fostering collaborative decision-making among leadership, committees, teams or work groups of diverse composition.

 Experience 

  • 5 years of clinical experience required.
  • 3 years of utilization review experience required.
  • Previous workload management experience preferred

 Mental and Physical Requirements        

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations will be made as required by law in an attempt to enable an individual with a disability to perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit for prolonged periods of time; key and/or control objects; interact extensively with internal and external customers; occasionally lift and/or move objects weighing up to 10 pounds; and occasionally travel within the state.

KEPRO offers challenging careers, excellent benefits and opportunities for advancement.  For consideration, please submit resume and cover letter with salary requirements. Only those candidates identified for an interview will be contacted. No Phone Calls Please.  Visit our website at www.kepro.com for more information on the KEPRO Family of Companies.

EOE AA M/F/Vet/Disability

KEPRO is an E-Verify employer. E-Verify is an internet based system operated by the Department of Homeland Security (DHS) in partnership with the Social Security Administration (SSA) that allows participating employers to electronically verify the employment eligibility of their newly hired employees in the United States.

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