[Hiring] Nurse Team Lead @WNS Global Services

Role Description

• Balances between case review production and team lead duties based on business needs and staffing levels
• Conducts case reviews as assigned
  • Maintains a minimum target of 3.5 cases per hour (CPH) when processing cases during productivity hours
• Monitors staff work assignments and adjusts the nurse assignment tool based on staffing levels, proficiency, types of request, and amount of cases received; frontline staff pull their assignments directly from the tool
  • Ensures case-specific turnaround time (TAT) related to client service level agreements and regulatory compliance requirements are met for their specified program(s)
  • Communicates expectations, assignments and responsibilities clearly and professionally
  • Acts as a liaison between frontline staff and upper management
• Assists with daily physician reviewer case coordination and notifications
• Monitors team performance to ensure proper processes are being followed and reports on areas of opportunity to Supervisor
  • Functions as a subject matter expert for assigned program modalities/procedures
  • Disseminates information, as appropriate, to staff members
  • Evaluates and monitors case work by team members to identify any gaps or outliers
  • Ensures that staff members are successful by providing support to new and existing staff as a valuable resource
  • Listens to team members’ feedback and resolves any issues or conflicts
  • Enables team members to ensure consistent quality service to provider and members
  • Collaborates with other departments, as assigned, to ensure proper protocol is being followed and obtain clarifications, as needed
• Conducts selected reviews/auditing of cases within the Clinical Review department to identify training opportunities based on appropriateness of the review determinations
  • Coordinates with Nursing Management and Clinical Review Training Department to identify educational and refresher training needs for individual nurses or across the Clinical Review Department
  • Conducts periodic one-on-ones with Clinical Review Nurses to offer tips on process improvement and clinical review
  • Identifies potential improvements in clinical review process and criteria
  • Participates in HH Nurse Education group email to provide responses to nurses’ questions regarding specific cases and clinical review processes
• Provide secondary Nursing Management coverage for assisting staff during Manager or Supervisor unavailability due to meetings, PTO, etc.
• Handles escalated inbound calls or requests from providers
• Assists with inventory management, including monitoring case volumes and queues to support timely assignment and completion
• Actively participates or conducts meetings as directed by Supervisor or Manager
• Develops, implements, and utilizes a multifaceted rewards system that makes team members excited to show up to work every day and do their best
• Uses empowerment, trust and other strategies as appropriate to develop and motivate team members
• Facilitates a healthy and motivating work environment and atmosphere
• Utilizes knowledge of AVAYA, ADP Workforcenow, and related systems to manage daily phone metrics
• Capable of collaborating with client personnel to resolve customers’ concerns
• Responsible for knowing the intricacies of all benefit management programs including applicable regulatory compliance, accreditation standards, and client/health plan service level requirements for each program, line of business, and geographic region
• Refers all complaints to Compliance Officer, as appropriate; works collaboratively with the Quality Department to investigate complaints and correct errors
• Evaluates and reports HIPAA breaches according to policy
• Collaborates with human resources to ensure adherence to company policies
• Promotes business focus which demonstrates an understanding of the company’s vision, mission, and strategy
• Creates, encourages, and supports an environment that fosters teamwork, respect, diversity, and cooperation with others
• Adheres to all HIPAA, state and federal regulations pertaining to the clinical programs
• Adheres to both URAC & NCQA standards pertinent to their job description
• Performs other related duties and projects as assigned
• Please note this job description is not designed to cover or contain a comprehensive list of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Qualifications

• Graduate of an accredited school of nursing
• Current active, unrestricted RN or LVN/LPN license in a state or territory of the United States required
• Minimum of 2 years of Utilization Management (UM) experience required; additional experience in QM, acute care, or managed care setting preferred
• Excellent interpersonal, written and presentation skills, including the ability to handle interactions with facility personnel, providers, members and various internal departments in a professional manner
• Demonstrates leadership and motivational skills
• Ability to work in a fast-paced, evolving environment, on-call after hours work may be required
• Ability to utilize critical thinking skills
• Experience in team interactions and improvement methods/projects (e.g., coaching quality and productivity)
• Understanding of HealthHelp’s products and services
• Strong interpersonal and communication skills
• Knowledge of Microsoft Office and programs including Outlook, PowerPoint, Excel, Word and Visio

Requirements

• Business office environment or HIPAA compliant remote location
• Ability to use telephone for up to 8 hours unassisted
• Ability to sit for up to 8 hours unassisted
• Ability to enter data for up to 8 hours unassisted
• Ability to view PC screen for up to 8 hours
• Ability to prioritize in a multi-task environment

Benefits

• Medical, dental, and vision insurance
• Paid time off (PTO), holidays, and sick leave
• 401(k) with company match or other retirement plan
• Life and AD&D Insurance
• Employee Assistance Program