This site uses cookies. To find out more, see our Cookies Policy

Supervisor, Clinical Review in Scarborough, ME at KEPRO

Date Posted: 7/3/2018

Job Snapshot

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.

Supervisor, Clinical Review

Summary Description

Supervises Review Operations day-to-day activities of the nurse reviewers and non- clinical employees in the assigned areas to successfully meet contract deliverables.  Assists in meeting contract deliverables related to the Review Department within budgetary parameters.

Accountabilities

•           Assures accuracy and timeliness of all applicable review type cases within contract requirements. 

•           Assesses, evaluates and addresses daily work load and queues; adjusts work schedules daily to meet the workload demands of the department.

•           Analyzes productivity of nurse reviewers.

•           Identify Clinical Reviewers’ orientation and continuous learning needs and in collaboration with the Manager, Operations, develops and implements plans to address those identified learning needs.

•           Responsible for the quality monitoring activities including identifying areas of improvement and plan implementation of improvement areas.

•           Maintains current knowledge base related to review processes and clinical practices related to the review processes; functions as the initial resource to nurse reviewers regarding all review process questions and/or concerns.

•           Functions as providers’ liaison and contact/resource person for provider customer service issues and problem resolution.

•           Performs all applicable review types as workload indicates.

•           Liaison for peer reviewers

•           Appropriate Department wide scheduling

•           Responsible for any and all coaching, mentoring, development, or disciplinary action as needed.

•           Ensure all departmental work instructions/ training materials are update to date and communicated to various team as needed.

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

Qualifications

•           Active RN licensure preferred.

•           ASN or equivalent nursing education required.  BSN or related Bachelor’s degree preferred.

Skills, Knowledge Abilities (SKA)

•           Excellent verbal and written communication skills essential.

•           Excellent interpersonal skills required.

•           Organizational skills, ability to plan and prioritize multiple assignments essential.

•           Computer proficiency in Microsoft Office and other software programs operating in a Windows environment.

Experience

•           Minimum of three (3) years supervisory experience in a health-care field with a minimum of 1-3 years review experience required.

•           Two years recent clinical experience.

•           Previous workload management experience strongly 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.

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.

CHECK OUT OUR SIMILAR JOBS

  1. Nurse Jobs
  2. RN Jobs