Clinical Operations Supervisor RN
4 weeks ago
The Clinical Operations Supervisor RN is responsible for overseeing the day-to-day clinical operations of the Appeals and Grievances department. This includes ensuring proper staffing and coverage, monitoring and evaluating departmental operations, and documenting and addressing any deviations in work or organizational expectations.
This role assists in triaging identified issues and forming resolutions within the scope of work and licensure. The Supervisor is a subject matter expert in Appeals & Grievances and supporting regulations, policies, protocols, and procedures.
This position serves as a formal and informal instructor, and escalates issues to the appropriate person when outside of their scope.
The Clinical Operations Supervisor RN ensures all functions of the Appeals and Grievances department are operating in accordance with the organization's mission, values, and strategic goals, which are focused on quality care delivery and continuous improvement.
This role supports the A&G Clinical Manager and assists in the development of programs, workflows, tools, training materials, orientation checklists, and competency checklists necessary to meet educational needs.
The position supervises all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports.
Duties- Ensures adequate distributions of workforce, assignments, and time off requests.
- Participates in the hiring and termination process, providing recommendations with supporting documentation.
- Monitors staff's performance, including productivity and compliance with regulatory requirements.
- Identifies, communicates, and coaches to improve staff performance.
- Develops tools, job aids, and workflows to optimize process flow, performance, and productivity of the A&G team.
- Completes intermittent and annual staff evaluations.
- Serves as the primary resource for all business-related questions and issues raised by staff.
- Recommends and implements process improvement measures to achieve departmental performance measures outcomes and goals.
- Plans and oversees A&G clinical activities according to the model of care, program description, and policy and procedures.
- Maintains all assigned reporting responsibilities and conducts regular audits to ensure compliance with community, industry, and organizational standards.
- Serves as a super-user on electronic programs and systems used by the department.
- Assists in the development of programs, workflows, tools, training materials, orientation checklists, and competency checklists necessary to meet educational needs.
- Trains new staff, remediation of seasoned staff, and cross-training as needed in specified business lines.
- Serves as a leader and role model, as well as a technical and informational resource for staff and peers.
- Fosters a culture that encourages employee contribution to ensure the department maintains an environment in which quality flourishes.
- Serves as a member/resource/liaison to the A&G Operations Team.
- Recommends resources to improve performance standards in terms of Appeals & Grievances.
- Collaborates with peers and colleagues within the organization to address process improvements, member needs, department, and organizational enhancements.
- Participates on internal and external committees as delegated or assigned.
- Serves as a consultant to other departments or organizations as needed.
This position requires work after hours, on weekends, holidays, a hybrid remote schedule, occasional flexibility in hours/shift in critical situations, and work on-call.
This position requires handling various caseloads and flexibility to adapt to changing priorities, which may include but are not limited to redistributed work assignments, team projects, and other priorities as assigned.
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