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Supervisor, Clinical Educator in Tampa, FL at KEPRO

Date Posted: 4/10/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    Tampa, FL
  • Job Type:
    Management
  • Experience:
    At least 5 year(s)
  • Date Posted:
    4/10/2018

Job Description

JOB TITLE:                Supervisor, Clinical Educator

REPORTS TO:           Review Operations Manager

DEPARTMENT:        Operations – Short Stay Reviews

Summary Description

Supervises educational operations day-to-day activities of the Clinical Nurse Educators for the required provider education associated with CMS' claims redetermination reviews. Assists in meeting contract deliverables related to the CMS claims redetermination reviews. 


Accountabilities

Maintaining lines of communication (verbal/written) between the BFCC QIO, healthcare providers and/or practitioners.

Assist in/oversight of the production of the written Final Review Result correspondence to include: individualized hospital results; claim-by-claim rationales; clinical details that can be used to foster further discussions and serve as basis for provider educational sessions.

Facilitate/oversight of one-on-one provider educational sessions.

Maintaining all timelines associated with claim determination reviews.

Providing monthly summaries/updates for the CMS report.

Functions as the initial resource to the clinical nurse educators and nurse reviewers regarding all pre or post educational review process questions and/or concerns.

Direct liaison between clinical nurse educators, physician reviewers, nurse reviews, support personnel, etc.

Assures accuracy and timeliness of all educational 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.

Assist/oversight of provider education session scheduling.

Analyzes productivity of clinical nurse educators.

Identify clinical nurse educators’ orientation and continuous learning needs. Develops and implements plans to address those identified learning needs.

In collaboration with Quality Improvement Specialist, responsible for the quality monitoring activities including identifying areas of improvement and plan implementation of improvement areas.

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

Performs all applicable educational review types as workload indicates.

Qualifications

  • Education (general level if required) or specific courses
  • §  Unrestricted, active RN license, required
  •  CCM, CPUR or other case management certification preferred

  • Skills, Knowledge

Abilities (SKA)

  • Excellent communication (written/verbal), interpersonal, organizational, time management and communication skills with a strong focus on customer service, including  building and maintaining relationships with internal/external customers
  • Organizational skills, ability to plan and prioritize multiple assignments with possible conflicting deadlines
  • Superior attention to detail w/analytical skills and demonstrated ability in decision-making
  • Demonstrated initiative and judgment in performance of job responsibilities, while maintaining professionalism, flexibility and dependability under pressure
  • Demonstrated experience in utilization of third party screening criteria/tools (Interqual, Milliman, etc.)
  • Ability to work independently and as part of a team
  • Interest in continuous learning and a commitment to staying informed on regulatory changes
  • Knowledge of CQI tools preferred.
  • Computer proficiency in Microsoft Office and other software programs operating in a Windows environment.
 
  • Excellent communication (written/verbal), interpersonal, organizational, time management and communication skills with a strong focus on customer service, including  building and maintaining relationships with internal/external customers
  • Organizational skills, ability to plan and prioritize multiple assignments with possible conflicting deadlines
  • Superior attention to detail w/analytical skills and demonstrated ability in decision-making
  • Demonstrated initiative and judgment in performance of job responsibilities, while maintaining professionalism, flexibility and dependability under pressure
  • Demonstrated experience in utilization of third party screening criteria/tools (Interqual, Milliman, etc.)
  • Ability to work independently and as part of a team
  • Interest in continuous learning and a commitment to staying informed on regulatory changes
  • Knowledge of CQI tools preferred.
  • Computer proficiency in Microsoft Office and other software programs operating in a Windows environment.


  • Experience
  • §  Minimum 5 years’ clinical experience in a short-term acute care hospital required
  • §  Minimum 5 years’ previous experience as a case management, utilization review, claims or risk manager, preferred
  • §  Minimum 3 years supervisory/managerial experience in an acute care or health plan setting required
  • Previous experience reviewing/investigating patient complaints and QI preferred
  • Previous teaching/educational experience preferred
  • 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.


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