This job is responsible for overseeing the team responsible for coordinating and delivering care to patients as part of payer programs authorized by their health insurance provider. The scope of this job includes providing operational and management oversight a team of clinicians and other members of the clinical team, but does not include providing clinical oversight to staff.

What we’re looking for:

• Strong acute-care clinical background with the ability to apply evidence-based guidelines.
• Proficiency with technology solutions, including Microsoft Office and utilization management support tools, familiarity with CarePort Care Management preferred.
• Licensed and located in New York State preferred, with the ability to obtain other clinical state licensures, as needed.
• Flexibility to work up to two weekend shifts per month and in alignment with the following business hours: 8:00a – 8:00p (staggered shifts) eastern time on weekdays, 8:00a – 4:00p on Saturdays, and 12:00p – 4:00p on Sundays, except for WellSky-recognized holidays.

We invite you to apply today and join us in shaping the future of healthcare!

Key Responsibilities:

• Oversee daily operations of clinical operation support staff and ensure tasks are completed efficiently and accurately.
• Serve as the primary point of contact for team communications by promoting collaboration and resolving minor operational challenges.
• Assist in the development and execution of work plans, assign tasks, and monitor completion to meet team goals.
• Provide direct support and guidance to team members, including on-the-job training and resource allocation.
• Ensure compliance with organizational policies and maintain accurate documentation of team activities.
• Monitor team performance metrics to identify areas for improvement and ensure quality service delivery.
• Perform other job duties as assigned.

Required Qualifications:

• Bachelor's Degree or equivalent work experience.
• 0-1 years of relevant management work experience.
• At least 4-6 years relevant work experience.
• Active RN License.
• 2 years clinical acute nursing experience.
• 1-2 years of hospital-based utilization management experience.

Preferred Qualifications:

• Bachelor's Degree in Nursing.
• Denials and Appeals experience.
• Experience with managed care and CMS standards.
• Proficient in the use of window-based computer programs.
• Excellent verbal, written, and interpersonal communication skills.
• Critical thinking skills, creative problem solving, and proficient organization and planning skills. 
• Experience with InterQual guidelines for acute-care and/or other clinical decision support tools, especially in utilization management and prior authorization processes.
• Experience with CarePort Care Management.

Job Expectations:

• Willing to travel up to 30% based on business needs.
• Willing to work additional or irregular hours as needed.
• Must work in accordance with applicable security policies and procedures to safeguard company and client information.
• Must be able to sit and view a computer screen for extended periods of time.

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# Remote

WellSky is where independent thinking and collaboration come together to create an authentic culture. We thrive on innovation, inclusiveness, and cohesive perspectives. At WellSky you can make a difference.

WellSky provides equal employment opportunities to all people without regard to race, color, national origin, ancestry, citizenship, age, religion, gender, sex, sexual orientation, gender identity, gender expression, marital status, pregnancy, physical or mental disability, protected medical condition, genetic information, military service, veteran status, or any other status or characteristic protected by law. WellSky is proud to be a drug-free workplace.

Applicants for U.S.-based positions with WellSky must be legally authorized to work in the United States. Verification of employment eligibility will be required at the time of hire. Certain client-facing positions may be required to comply with applicable requirements, such as immunizations and occupational health mandates.

Here are some of the exciting benefits full-time teammates are eligible to receive at WellSky:

• Excellent medical, dental, and vision benefits
• Mental health benefits through TelaDoc
• Prescription drug coverage
• Generous paid time off, plus 13 paid holidays
• Paid parental leave
• 100% vested 401(K) retirement plans
• Educational assistance up to $2500 per year