[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.
• Provides 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.
• Minimum of 1 year of Supervisory Experience.
• 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.