Posted in Other 30+ days ago.
Role Summary:
The Clinical Supervisor (RN) will oversee a team of 20 to 30 remote Medical Review Nurse Analysts (NA) that complete Targeted Probe and Educate (TPE) work for our Medicare contract. The primary purpose of this leadership role is to provide coaching to team members on production of work, quality of their reviews and education delivery to providers. This role contributes to WPS by ensuring that our Medical Review strategy is implemented in accordance with Centers for Medicare & Medicaid Services (CMS) guidelines to achieve award fee validation and contract reviewal. This is a hybrid role that will work from home and in the office. You will report to one of our WPS offices approximately 4 to 8 times a month.
In this role you will:
This job profile is not intended to be an exhaustive list of all duties or responsibilities associated with the job. Other job-related duties may be assigned.
This role could be a good fit if you:
You'll benefit from this experience by:
You need to have:
We also prefer:
Compensation and Benefits
Who We Are
WPS Health Solutions is an innovator in health insurance and a worldwide leader in claims administration, serving millions of beneficiaries in the United States and abroad.
Founded in 1946, WPS offers health insurance plans for individuals, families, and seniors, and group plans for small and large businesses. We are a world-class claims processor and program administrator for the government's Medicare program. And we manage benefits for millions of active-duty and retired military personnel and their families.
WPS has been named one of the World's Most Ethical Companies by the Ethisphere Institute for 10 years in a row.
Our Purpose and Values
Our purpose is to make healthcare easier for those we serve. Click Here
Our values - Customer Focused, Individual Responsibility, Mutual Respect, and Driven & Passionate - are the core of who we are and how we conduct business every day.
Links and descriptions for:
Health Insurance
WPS Health Insurance offers high-quality health insurance plans for individuals and families, Medicare supplement plans for seniors, and group health plans for businesses of every size.
http://wpshealthsolutions.com/business-units/wpshi.shtml
Military and Veterans Health
WPS Military and Veterans Health administers claims and provides customer service and related activities for the U.S. Department of Defense and the U.S. Department of Veterans Affairs and their beneficiaries.
http://wpshealthsolutions.com/business-units/wpsmvh.shtml
Government Health Administrators
WPS Government Health Administrators manages Medicare Part A and Part B benefits for more than 7 million beneficiaries. As one of the largest contractors for the Centers for Medicare & Medicare Services, we've served Medicare beneficiaries and their health care providers since 1966.
http://wpshealthsolutions.com/business-units/wpsgha.shtml
Arise
Arise Health Plan provides innovative and high-value health plans to groups and individuals in eastern and northeastern Wisconsin. With our quality Wisconsin-based customer service, Arise offers health care expertise with a personal touch.
http://wpshealthsolutions.com/business-units/arise.shtml
EPIC Specialty Benefits
EPIC Specialty Benefits provides businesses group insurance products that cover:
http://wpshealthsolutions.com/business-units/epicsb.shtml
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