NJM Insurance Group

Supervisor, Clinical Ops

NJM Insurance Group

full-time

Posted on:

Location Type: Remote

Location: New Jersey • United States

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Salary

💰 $87,300 - $119,070 per year

About the role

  • Manages, analyzes and coordinates the daily activities of the unit to ensure departmental productive goals are met with regards to quality timeliness, accuracy and consistency of medical decisions.
  • Ensures staff meets all regulatory requirements and comprehends and complies with best practices, professional standards, internal policies and procedures.
  • Conducts continuous evaluation of workflows and seeks to improve processes that impact the department.
  • Coordinates data collection, reviews compliance reporting and identifies opportunities for improvements.
  • Identifies and implements cost saving/revenue generating opportunities.
  • Serves as key liaison between Medical Directors, Management leadership, and staff.
  • Also serves as a medical resource to members and providers, as well as non-clinical staff.
  • Develops key performance indicators to evaluate level of service for internal and external customers.
  • Acts as a subject matter expert for difficult and complex matters.
  • Represents the Plan with external customers, providers and agencies.
  • Represents the department on internal committees and participates in special projects.
  • Assists Manager in coordinating regulatory, quality and accreditation activities.
  • Performs other duties as assigned by management.
  • Creates and champions an atmosphere within the team, which fosters open communication, teamwork, ownership, and a collaborative cross-departmental environment to implement, optimize and share continuous improvement processes.
  • Manages, directs, and develops staff by providing feedback and coaching.
  • Administers performance and salary reviews for staff.
  • Ensures staff meets all regulatory requirements and comprehends and complies with best practice methodology, professional standards, and internal policies and procedures.
  • Assists in preparing and monitoring the budget to ensure administrative cost objectives are met.

Requirements

  • Requires a Nursing degree or a Masters in a Behavioral health related field or a Bachelors in a health related field.
  • Requires a minimum of two years' full time acute healthcare/direct clinical care experience to the consumer.
  • Requires a minimum of one year direct supervisory experience or demonstrated supervisory experience leading teams in a matrix management environment.
  • Prefer certification as a case manager.
  • Prefer minimum of three years’ experience as a case manager.
  • Requires minimum of 12 months experience in a managed care setting or the health insurance industry.
  • Active Unrestricted NJ LCSW, LMFT, LPC, or RN/PT License Required.
  • Medicaid Case Management Only: Active Unrestricted NJ LSW, LCSW, LMFT, LPC, or RN/PT License Required.
  • Requires knowledge of Utilization Management (UM) and managed care principles.
  • Requires knowledge of the Case Management/Disease Management Standards of Practice.
  • Requires knowledge of health care systems and medical documentation.
  • Requires knowledge of State Mandates and Regulations.
  • Requires knowledge of regulatory bodies and their processes.
  • Requires knowledge of NCQA accreditation standards.
  • Requires knowledge of community health resources.
Benefits
  • Comprehensive health benefits (Medical/Dental/Vision)
  • Retirement Plans
  • Generous PTO
  • Incentive Plans
  • Wellness Programs
  • Paid Volunteer Time Off
  • Tuition Reimbursement
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
Nursing degreeMasters in Behavioral healthBachelors in health related fieldAcute healthcare experienceSupervisory experienceCase management certificationUtilization Management (UM)Managed care principlesMedical documentationNCQA accreditation standards
Soft Skills
LeadershipCommunicationTeamworkCoachingCollaborationProcess improvementPerformance evaluationProblem-solvingLiaison skillsOrganizational skills
Certifications
Active Unrestricted NJ LCSWActive Unrestricted NJ LMFTActive Unrestricted NJ LPCActive Unrestricted RN LicenseActive Unrestricted PT LicenseCase management certification