Universal American
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RN Clinical Supervisor - Transitional Care

Job Title
RN Clinical Supervisor - Transitional Care
Job ID
816028
Begin Date
8/15/14
Duration
Location
Houston,  TX
Other Location
Description
Do you love healthcare and helping others? Do you excel at teaching members about their health and well-being? Are you looking for an opportunity to empower others, while maintaining a strong work/life balance? Universal American is the place for you!

Universal American is a New York Stock Exchange company with annual revenues of more than $2 billion. Through our family of healthcare companies, we provide health benefits to people covered by Medicare and/or Medicaid. We are dedicated to working collaboratively with healthcare professionals in order to improve the health and well-being of those we serve and reduce healthcare costs.

Well-capitalized and highly entrepreneurial, Universal American has been on the cutting edge of healthcare for more than 21 years. We offer Medicare Advantage plans to people with Medicare. We partner with providers in Accountable Care Organizations that serve people with Original Medicare. And we provide array of healthcare services to states, municipalities, health plans and other entities in the world of Medicaid. In everything we do, we focus on improving the coordination of healthcare through collaboration between payers, providers and patients to achieve the best health outcomes possible.

We have an exciting opportunity for a RN Clinical Supervisor to work in the Houston area. The Clinical Supervisor is responsible for coordinating, monitoring, evaluating and facilitating high quality, cost effective care related to medical /case management.  This individual assists in the development, organization, direction and maintenance of all Care Management functions for the department. The supervisor provides oversight in the day-to-day care management activities and works independently with little supervision.

Responsibilities:
•Coordinates care services for members as prescribed by the department's policy, CMS guidelines, and medical necessity of the member.
•Monitoring of staff productivity.
•Monitors referrals and care management activities by adjusting staffing and work assignments as needed to maintain productivity standards.
•Maintains appropriate levels of utilization. Assists in analyzing utilization reports and developing strategies for operational improvements as needed.
•Assists in implementation of operational changes in order to improve efficiency of processes and meet the plans strategic goals.
•Serves as a clinical resource to the care managers and non-clinical staff.
•Resolve complaints in a positive manner with tact and diplomacy within established time frames.
•Continuously monitor status and impact of care coordination, care management and adjusts plan accordingly.
•Maintains awareness of federal legislation effecting case management services.
•Ensures clinical staff complies with CMS department, health plan policies and procedures.
•Assists Manager with orienting, training and counseling clinical staff when needed.
•Functions as a facilitator with regard to workplace departmental issues.
•Promotes plan's overall organizational and financial goals as well as improvement in overall quality of the member's health care as the primary goal of any initiative.
•Responsible for the daily management of appointed staff and work in collaboration with other departments to achieve outcome goals for member Health and Wellness, chronic condition, and care management.
•Interacts with Provider Relations to promote a coordinated approach and support for each department's initiatives and communicates consistent messages in all interactions.
•Facilitates care coordination, care management interaction and problem solving through collaboration between Care Management staff and Medical Director as indicated.
•Participate in regular team meetings for communication and feedback, staff training and development, sharing of program results, and collaborative problem solving.
•Complies with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable, and defined in the Universal American Corporate and department policies.
•And all other duties assigned by the manager and/or supervisor.

Required Skills:
•Professional verbal and written communication skills, with the ability to clearly articulate thoughts and ideas
•Organizational skills with the ability to handle multiple tasks and/or projects at one time
•Customer service skills with the ability to interact professionally and effectively with providers, third party payers, physicians, and staff from all departments within and outside the Company
•Analytical and interpretation skills including departmental, utilization, financial and operations data
•Decision-making skills with the ability to investigate and weigh alternatives and select the course of action that provides the greatest benefit to the organization
•Creative thinking skills with the ability to ask the needed bigger-picture questions that lead to process and team improvements
•Time management skills with the ability to prioritize and schedule daily activities for the most efficient use of time
•Problem solving skills with the ability to look for root causes and implementable, workable solutions
•Interpersonal skills with the ability to work in a fast-paced environment and participate as an independent contributor with little supervision or as an active team member depending on the situation and needs
•Leadership skills with the ability to empower, engage, motivate, evaluate and manage team members individually and as a group
•Must have a track record of producing work that is highly accurate, demonstrates attention to detail, and reflects well on the organization

Required Experience:
•Must possess a current RN license in the state of Texas
•An Associate's or Bachelor's degree in nursing, health and gerontology or a related field, preferred
•BSS or CCM a plus
•Minimum of three years' relevant nursing experience in clinical experience in a hospital setting, health care or human services is preferred
•Minimum of 3 years' previous supervisory experience that may include Quality Assurance, Utilization Management and or Care/ Disease Management
•Experience, of at least one year, in conducting assessments, developing care plans, and monitoring home and community-based services
•Experience in conducting social and health assessments
•Personal computer experience should include working with Microsoft Word, Excel, PowerPoint and Outlook at the intermediate level at a minimum
•Knowledge of human behavior, family/caregiver dynamics, human development and disability
•Experience identifying and working with various community resources and services

Universal American Corp. is an Equal Opportunity / Affirmative Action Employer and does not discriminate because of age, color, disability, ethnicity, marital or family status, national origin, race, religion, sex, sexual orientation, military veteran status, or any other characteristic protected by law. We are committed to attracting, retaining and maximizing the performance of a diverse and inclusive workforce.
Required Skills

•Must possess a current RN license in the state of Texas
•An Associate's or Bachelor's degree in nursing, health and gerontology or a related field, preferred
•BSS or CCM a plus
•Minimum of three years' relevant nursing experience in clinical experience in a hospital setting, health care or human services is preferred
•Minimum of 3 years' previous supervisory experience that may include Quality Assurance, Utilization Management and or Care/ Disease Management
•Experience, of at least one year, in conducting assessments, developing care plans, and monitoring home and community-based services
•Experience in conducting social and health assessments
•Personal computer experience should include working with Microsoft Word, Excel, PowerPoint and Outlook at the intermediate level at a minimum
•Knowledge of human behavior, family/caregiver dynamics, human development and disability
•Experience identifying and working with various community resources and services
Openings
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