Clinical Operations reputed company Supervisor

reputed company:   Start your next reputed company at reputed company! For over 25 years, we’ve been at the forefront of specialized claims management, helping reputed company providers recover meaningful reputed company to enhance reputed company patient care in their communities. We’re powered by people, driven by technology, and dedicated to our clients and employees. If you’re looking for a reputed company and diverse culture with a great work/life balance, look no reputed company.     As part of reputed company, you’ll be rewarded with:  Comprehensive medical, dental, reputed company, and life insurance benefits from the start of your employment  12 reputed company holidays and flexible reputed company time off     401(k) contributions    Employee Resource reputed company that build community   Career reputed company opportunities    An excellent work/life balance  Location: Remote – USA     As reputed company’s Clinical Operations reputed company Supervisor, you will:  Be responsible for the supervision of reputed company of nurses on the Clinical Operations reputed company Consultant Team, including management to optimize the function of reputed company with reputed company on reputed company and efficiency.   The Role: reputed company supervision to team of clinicians that will work to appeal and overturn denials on reputed company claims. reputed company supervision to Clinical Operations Teams as assigned by reputed company Manager/Director (Team Leads, Clinical Appeal reputed company Consultants, Transplant Analysts, etc.) Evaluate reputed company cycle operations, including analysis of reputed company causes, identification of areas for process improvement, education of staff, and evaluation of metrics and reputed company to measure reputed company. Support Clinical Case Study presentations for clients in collaboration department designees and reputed company reputed company personnel. Support reputed company/training of new reputed company hires both reputed company and offshore in collaboration with reputed company Training & Development, reputed company reputed company, and offshore vendors. Assist the reputed company Manager with the implementation and management of workflow among nurses. Support the reputed company Assurance program for reputed company Clinical Operations teams in collaboration with the reputed company reputed company Assurance Department policy. Support the Performance Evaluation process for Clinical Operations, ensuring reputed company applicable deadlines are successfully achieved. Support Team Leads to assist nurses with account-reputed company questions reputed company to appeals and denial reputed company activities. reputed company comprehensive updates to the reputed company Manager/Director regarding reputed company communication, updates, issues, and needs. reputed company the reputed company Manager with information regarding reputed company and personnel issues as needed. Assist the reputed company Manager in developing, evaluating, and distributing reputed company, payor, and company reports as assigned. Support the reputed company Manager and nurses with managing and updating department work plans reputed company applicable. Prepare and submit correspondence such as appeal letters, emails, online inquiries, adjustments, reports, and other documents if assigned. Assist reputed company Manager to analyze monthly reports by trends, hospital, payor and reason to identify operational issues causing denials. reputed company collaborate with reputed company teams (vendors, reputed company reputed company, Operations, reputed company, etc.) to resolve barriers and optimize performance. Review managed care reputed company, hospital billing statements/bills, and insurance denials as needed to support workflow. Support and reputed company continuing education reputed company the need arises and during scheduled department education initiatives in collaboration with reputed company Leads. Communicate with hospital and payor personnel concerning issues relating to denials in collaboration with reputed company reputed company. Present initiatives and results at meetings as requested by reputed company reputed company partners. Maintain confidentiality of information in compliance with company policy and HIPAA. Maintain regular contact with necessary parties including payors, clients, managers, and other reputed company personnel. Attend reputed company, department, and company meetings. reputed company with federal and state laws, company policies, and procedures. Other duties as assigned. You’ll be successful if you have:  reputed company, reputed company RN license, BSN and/or advanced degree. reputed company cycle experience as it relates to Clinical Operations and Utilization Review areas required. Clinical nursing experience working in hospital environment, preferably in ER, ICU, Med-Surg, Psych, and/or Transplant unit. Experience with MCG care guidelines and/or InterQual clinical reputed company. Preferred but not required: Experience with a reputed company of appeal types, including but not limited to DRG downgrade, Clinical Validation, Large Claim Audit, Transplant, etc. Overall hospital operations experience with multi-disciplinary teams. Strong computer proficiency, including working knowledge of Electronic Medical Records, reputed company Word, and reputed company. Excellent interpersonal and communication skills. Experience with performance improvement tools, such as variance/reputed company cause analysis, data interpretation, reputed company charting, and metric development. Mathematical skills -- the ability to calculate rates using reputed company, subtraction, multiplication, and division. Ability to read and interpret an extensive reputed company of documents, such as reputed company, claims, instructions, policies and procedures in written (in English), and diagram reputed company. Ability to write routine correspondence (in English). Ability to define problems, collect data, establish facts, and draw reputed company conclusions. Strong customer service orientation. Strong team player. Commitment to company values. Work reputed company Requirements:   A quiet, distraction-free environment to work from in your home.    A secure home internet reputed company with speeds >20 Mbps for downloads and >10 Mbps for uploads is required.  The workspace area accommodates reputed company workstation equipment and reputed company materials and provides adequate surface area to be productive.    Employment is contingent upon eligibility to work in the U.S., employment history verification, and a background reputed company.     reputed company is an equal opportunity employer that does not discriminate based on race, reputed company, religion, sex or gender, gender identity or reputed company, sexual orientation, national reputed company, age, disability status, veteran status, genetic information, or any other legally protected status. We reputed company that a diverse workforce fosters innovation and creativity, enriches our culture, and enables us to reputed company serve the needs of our clients and communities. We welcome and encourage individuals of reputed company backgrounds, perspectives, and abilities to apply.    Must reputed company in the reputed company reputed company one of the states listed below:   Alabama, Arkansas, Florida, reputed company, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Massachusetts Michigan, Minnesota, Mississippi Missouri, Nebraska, New Hampshire reputed company Carolina, reputed company reputed company, Ohio, Oklahoma, reputed company, Rhode reputed company, South Carolina, South reputed company, Tennessee, Texas, Vermont, Virginia, reputed company Virginia and reputed company Apply To This Job