Join to apply for the Clinical Manager role at WPSA health solutions company 2 days ago Be among the first 25 applicants Join to apply for the Clinical Manager role at WPSA health solutions company Get AI-powered advice on this job and more exclusive features. Role Snapshot Our Clinical Manager is accountable for planning, organizing, managing, and evaluating clinical operations for Medical Review. This includes developing Centers for Medicare & Medicaid Services (CMS) reports as well as managing activities to ensure accurate rendering of claim decisions. The role collaborates with other business areas to ensure WPS and CMS goals and objectives are met utilizing cost-effective, timely, accurate, and innovative methods. The Clinical Manager is accountable to ensure compliance with regulatory and payor guidelines. Role Snapshot Our Clinical Manager is accountable for planning, organizing, managing, and evaluating clinical operations for Medical Review. This includes developing Centers for Medicare & Medicaid Services (CMS) reports as well as managing activities to ensure accurate rendering of claim decisions. The role collaborates with other business areas to ensure WPS and CMS goals and objectives are met utilizing cost-effective, timely, accurate, and innovative methods. The Clinical Manager is accountable to ensure compliance with regulatory and payor guidelines. Salary Range $98,000-$120,000 The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, and experience. Work Location We are open to remote work in the following approved states: Arizona, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Jersey, North Carolina, North Dakota, Ohio, South Carolina, South Dakota, Texas, Virginia, Wisconsin Hybrid Work New employee that live within 45 miles of WPS Headquarters (1717 W. Broadway in Madison, WI) will be expected to be able to be able to work Hybrid 2 days a week on a regular basis. Onsite work will be tailored for team cohesion, strategy, planning and collaboration. How do I know this opportunity is right for me? If you: Possess strong critical thinking skills, are comfortable with change and ambiguity in an evolving and progressive department focused on reengineering the way we work. Enjoy leading a team of nurses and understand how metrics and process improvement can help improve overall productivity of our team and ensuring timely completion of prior authorization requests. Want to develop, implement, and maintain the Improper Payment Reduction Strategy (IPRS) for Medical Review. Can ensure compliance with federal and state regulations, CMS guidelines, and company policies. Like to keep an eye on industry trends and data that can impact productivity and timeliness and are able to implement solutions, if necessary. Can track and monitor clinical concerns raised by CMS, other CMS contractors, and other clinical areas. Enjoy leading and helping teams grow and have a history of making decisions independently without guidance. What will I gain from this role? Leadership experience in a thriving environment focused on integrity, Kindness, Authenticity, and Imagination. Technical leadership and oversight in collaborating with internal teams to improve workflows Experience working in an environment that serves our nations military, veterans, Guard and Reserves, and Medicare beneficiaries. Working in a continuous performance feedback environment Minimum Qualifications Associates Degree in Nursing (ASN) or Bachelors Degree in Nursing (BSN). Active RN license, applicable to state of practice in good standing. 5 or more years of clinical experience in a healthcare setting. 3 or more years in a leadership role. Extensive knowledge and understanding of CMS guidelines and regulations. Strong analytical, problem-solving, and organizational skills with the ability to manage multiple cases simultaneously and meet strict deadlines. Extensive knowledge and understanding of medical/clinical review processes. Excellent reading comprehension, written and verbal communication skills, with the ability to communicate complex medical information clearly and concisely. Proficient in Microsoft Office tools with experience working in electronic health records. Preferred Qualifications Experience working for a Medicare Administrative Contractor (MAC). Experience with home health and hospice (HH&H). Remote Work Requirements Wired (ethernet cable) internet connection from your router to your computer High speed cable or fiber internet Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at https://speedtest.net) Please review Remote Worker FAQs for additional information Benefits Remote and hybrid work options available Performance bonus and/or merit increase opportunities 401(k) with a 100% match for the first 3% of your salary and a 50% match for the next 2% of your salary (100% vested immediately) Competitive paid time off Health insurance, dental insurance, and telehealth services start DAY 1 Professional and Leadership Development Programs Review additional benefits: (https://www.wpshealthsolutions.com/careers/fulltime_benefits.shtml) Who We Are WPS, a health solutions company, is a leading not-for-profit health insurer and federal government contractor headquartered in Madison, Wisconsin. WPS offers health insurance plans for individuals, families, seniors and group health plans for small to large businesses. We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad. WPS has been making healthcare easier for the people we serve for nearly 80 years. Proud to be military and veteran ready. Culture Drives Our Success WPS culture is where the great work and innovations of our people are seen, fueled and rewarded. We accomplish this by creating an open and empowering employee experience. We recognize the benefits of employee engagement as an investment in our workforceboth current and futureto effectively seek, leverage, and include differing and unique perspectives that fuel agility and innovation on high-performing teams. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities. We are proud of the recognition we have received from local and national organization regarding our culture and workplace: WPS Newsroom - Awards and Recognition. Sign up for Job Alerts FOLLOW US! Instagram LinkedIn Facebook WPS Health Blog This position supports services under Centers for Medicare & Medicaid Services (CMS) contract(s). As such, the role is subject to all applicable federal regulations, CMS contract requirements, and WPS internal policies, including but not limited to standards for data security, privacy, confidentiality, and program integrity. CMS contractors and their personnel are subject to screening and background investigation prior to being granted access to information systems and/or sensitive data to safeguard government resources that provide critical services. Seniority level Seniority level Mid-Senior level Employment type Employment type Full-time Job function Job function Health Care Provider Industries Insurance Referrals increase your chances of interviewing at WPSA health solutions company by 2x Sign in to set job alerts for Clinical Manager roles. 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