Medical Case Management WC/UR Supervisor

Medical Case Management WC/UR Supervisor

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Position Summary:

The Supervisor is accountable for overseeing the performance of their assigned team. They play a key role in implementing company best practices to achieve departmental goals and objectives. This position involves close collaboration with the Nurse Triage, Utilization Review, Case Management and Pharmacy teams. The Supervisor must have up-to-date knowledge of evidence-based nursing practices and demonstrate strong critical thinking skills in applying the case management process at all stages.

Essential Duties and Responsibilities:

Possess excellent communication and organizational skills to interface with the client, claimants and staff. Working well independently and setting priorities is essential.

The Supervisor manages daily operations, ensuring updated information is maintained, customer service standards are met, and complaints are effectively resolved.

Additionally, the Supervisor is responsible and accountable for Human Resource functions, including recruitment, performance improvement, quality assurance, and ensuring compliance with client expectations and guidelines, while also meeting unit goals.

Primary Responsibilities include:

• Represents the company in a professional manner to both internal and external customers and clients.
• Assures performance standards of the team through continued training and coaching, quality assurance along with regular performance evaluations.
• Responsibilities include providing clinical, technical and operational support and direction, including organization and department procedures.
• Monitors staff work assignments and makes appropriate adjustments based on staffing levels
• Provides coaching and training to improve productivity of staff members within team.
• Assists in training of new staff and ongoing training to ensure staff’s ability.
• Reviews quality audits and shares audit results promptly with associates, providing necessary education and training to improve performance.
• Works collaboratively with the Manager and identified TMC leadership team to develop and implement performance measures, and monitors associates placed on performance improvement plans.
• Responsible for completing annual reviews for direct reports with Manager input.
• Creates and supports an environment that fosters teamwork, cooperation, respect, and diversity.
• Ensures staff compliance with Case Management laws and mandated regulatory requirements
• Foster a positive working environment with a focus on the overall goals within the department.
• Monitor and continue to develop workflows within the department.
• Utilizes jurisdictional knowledge of regulatory rules, statutes and procedures governing the jurisdictions assigned to ensure compliance.
• Assists in developing and overseeing the implementation of common case management practices and procedures with assigned team members
• Ensures consistent and complete compliance with TRISTAR’s policies and procedures.
• Maintains communication among staff members in the department and communicates with management team.
• Participation in management team and supervisory meetings
• Participates in Quality Management Committee meetings
• Participates in client stewardship and implementation meetings as necessary
• Miscellaneous duties and special projects as needed, including maintenance of current knowledge of workers’ compensation laws and rules to ensure recommendations follow laws/rules, and participation in necessary continuing education to remain current in clinical diagnosis, procedures, treatment and clinical/legal issues.

Additional Functions and Responsibilities

• Excellent written and verbal communication skills necessary for staff and client contact, presentations, and personnel management.
• Excellent leadership skills, with a demonstrated ability to motivate staff and obtain results through teamwork.
• Ability to function effectively under time constraints, consistently meet deadlines and manage multiple tasks in a changing work environment.
• Ability to attend meetings and travel overnight/occasional
• Computer proficiency with ability to use common computer applications – Microsoft program, Word, Excel, PowerPoint.
• Knowledge of case management and cost containment
• Adhering to URAC standards and company policies and procedures
• Maintain confidentiality- Knowledge of laws and regulations pertaining to HIPPA and PHI

Qualifications

Education/Experience

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.

• RN with current unrestricted state licensure associate or bachelor’s degree in nursing and or Master’s level or higher in Health, Psychology, or Social Services.
• 3 years clinical practice experience required.
• Certification as a CCM (CRC, CDMS, or current CRRN), or willingness to pursue.
• Workers Compensation case management experience preferred.

Key Competencies:

• Basic Computer proficiency (Microsoft Office Products including Word, Outlook, Excel, Power Point); which includes navigating multiple systems.
• Ability to effectively communicate telephonically and in written form.
• Must meet productivity & quality expectations.
• Ability to organize and prioritize daily work independently and effectively.

Equipment Operated/Used:

• Essential Equipment: Desk, Telephone/Fax, Computer Keyboard, Mouse
• Essential Tools: Pens, pencil, computer, Keyboard
• Essential Vehicles:  Valid driver’s license required

Special Equipment or Clothing:

Professional attire adhering to the Company Dress Code

Here are some of the benefits you can enjoy in this role:

• Medical, Dental, Vision Insurance
• Life & Disability Insurance
• 401(k) plan
• Paid holidays
• Paid time off
• Referral bonus