Supervisor Medical Review - 300180

* Position is eligible for Remote / Work from Home opportunity *

Prefer experience in Part A or Part B Medicare Medical Review and Program Integrity

Job Summary

The Supervisor Medical Review (MR) provides guidance, leadership, planning, and reporting to appropriate individuals. This position supervises clinical staff to ensure the business unit is administering the organization's contracts with the best possible service while maintaining contract expectations and within budget constraints while optimizing staffing levels.

Key Performance Indicators

• Ability to lead and develop staff
• Excellent coaching and training abilities
• Ensures MR goals are met

Essential Functions

Key Duties/Responsibilities/Accountabilities

• Ensures the organization meets contractual obligations and performance standards including meeting or exceeding Contractor Performance Evaluation (CPE) standards in coordinating workloads for a multiple state contractor while operating within the Medicare and Corporate budgets.
• Maintains a strong technical understanding of the systems used to manage Medicare business and the interrelationships between teams and system usage.
• Serves as a resource point for internal/external customers.
• Serves as a primary contact to the Centers for Medicare & Medicaid Services (CMS) and other external contacts on Medicare operations.
• Maintains knowledge of the Statement of Work (SOW) for MR including operational work, reporting, and deliverables.
• Coaches and develops clinical and frontline staff by encouraging growth and ensuring staff are meeting performance expectations.
• Initiates disciplinary action when performance does not meet expectations.
• Leads by example by promoting team work, recognition, and leadership while demonstrating company values.
• Responds to and implements change in a flexible, positive manner.
• Participates as the area subject-matter expert to support responsiveness to our customers (CMS, providers/suppliers, other teams within the organization, and its employees) as needed.
• Communicates accurate, concise information internally and externally.
• Participates in budget process for area.
• May perform medical review work in support of employees when work load is high.
• Operates within and maintains knowledge of the MR budget.

Non-Essential Duties and Functions

• Other duties as assigned.

Requirements

Qualifications

Minimum Qualifications:

• Associate Registered Nurse degree (ASN) with active Registered Nurse License OR Certified Professional Coder (CPC) certification - Dependent upon department needs
• 2 years' clinical experience of which 1 year is in the general area of medical/utilization review

Preferred Qualifications:

• Bachelor's Degree in Nursing (BSN) or willingness to obtain a BSN within 2 years
• Active, unrestricted RN license
• Knowledge of Medicare Rules and Regulations
• Strong written and verbal communication skills
• Strong PC skills
• Ability to build effective interpersonal relationships within the workplace
• Ability to motivate and manage a large group of people
• Ability to direct and maintain a productive and conducive working environment
• Ability to coordinate activities among team
• Ability to problem solve and develop problem solving skills within staff and oneself
• Strong analytical skills and attention to detail

Environment and Cognitive/Physical Demands

• Office Environment
• Ability to read, hear, speak, keyboard, reason, communicate effectively and problem solve
• Requires prolonged sitting and telephone usage
• Requires the use of office equipment such as computer terminals, telephones, copiers and printers
• Infrequent lifting up to 15 pounds
• Infrequent stooping
• Travel up to 25%

Segregation of Duties

Every employee is responsible to perform their duties and responsibilities in accordance with Noridian values, policies and procedures, including but not limited to, Segregation of Duties Principles, HIPAA Security and Privacy, CMS requirements, the Noridian Compliance Program, and any other applicable laws, rules and regulations.

Statement of Other Duties

This document describes the essential functions, requirements, and responsibilities of this job, and is not intended to be a complete list of all tasks and functions. Employees may be requested to perform job related tasks other than those specifically listed in this description, and may be required to perform any task requested by the supervisor or by management.

CMS Access Compliance and Regulation Contingency Statement

Some positions require compliance with (i) federal and agency-specific regulations and related clauses included in NHS's prime contracts with the Government, (ii) background checks, and (iii) eligibility for a government-issued identification card.

Other Information

Job Posting Policy 6.05

New employees with Noridian Healthcare Solutions will be eligible to apply for positions within their assigned department after successfully completing a 90-day review. For positions outside your department, you must attain a minimum of six months of service before you can apply.

Equal Employment Opportunity

Equal Opportunity Employer of Minorities, Females, Protected Veterans and Individual with Disabilities, as well as Sexual Orientation or Gender Identity.

For questions, please email careers@noridian.com.

This job posting will be closed 12/03/2018 at 8:00AM CST. No further applications will be considered.