Remote Supervisor, Appeals & Grievances (RN)

Job Overview

  • Clinical License RN
  • State(s) Nationwide

Full job description

General Description:

The Quality Assurance and Clinical Services Manager will work closely with the VP of Quality Assurance & Clinical Services and the Quality Assurance team. They are responsible for managing and reviewing companywide clinical issues; including working with all local offices. This position serves as a clinical and professional liaison between office talent and field talent. The Quality Assurance and Clinical Services Manager has clinical expertise and is familiar with the field talent practices and procedures. They rely on extensive experience and judgment to plan and accomplish goals using Company core values of Integrity, Candor, Accountability, Respect and Excellence.

What you will be doing:

  • Acts as a clinical and professional liaison for office and field talent and clients; counsels, coaches and coordinates talent contract concerns; cancellations or terminations when requested by client or office talent
  • Coordinates internal communication/documentation of field talent contract counseling; cancellations or terminations with Supplemental Health Care (SHC) to determine eligibility status
  • Coordinate and teach clinical client-specific orientations
  • Generates monthly reports of Quality Assurance / Risk Management issues for SHC to VPQACS
  • Assess client, office and field talent inquiries regarding clinical practice issues including infection control issues; available to assess problems immediately upon occurrence
  • Performs duties and functions in accordance with SHC’s policies and procedures
  • Serves as back-up consultation to the VPQACS for clinical concerns for field talent and clients
  • Under the direction of the VPQACS, ensures that Joint Commission, contractual, legal and regulatory standards are being met
  • Supports and assists VPQACS with achieving and maintaining Joint Commission certification
  • Performs on-call after hours support as needed
  • Assists with clinical practice issues and projects as needed
  • Serves on clinical practice committees as needed
  • Help to create an environment of high morale, motivation and teamwork
  • Maintain company core values of Integrity, Candor, Accountability, Respect and Excellence
  • Other duties as assigned

Qualifications:

  • Minimum of current RN license required, Bachelor’s Degree preferred
  • Minimum of 5 years Nursing experience (8 years Nursing experience for Senior level role), with a minimum of three years in a supervisory/management position required
  • Maintenance of current, active license to practice in healthcare related profession
  • Maintenance of continuing education requirements of healthcare related profession
  • Knowledge of proper grammar, spelling and rules of composition
  • Must have a working knowledge of computers and software systems including Microsoft Office products and the Internet
  • Must be detail-oriented and highly organized
  • Ability to work independently and with other team members
  • Ability to organize and complete work in a timely manner
  • Ability to multi-task
  • Ability to communicate effectively with all levels of the organization
  • Ability to read and write English
  • Ability to understand medical terminology
  • Must be able to work for prolonged periods of sitting, typing and use of the phone and computer
  • Must successfully complete onboarding training/tutorials and attend future webcasts/trainings as required

What we want to offer you:

  • An Industry best, un-capped commission plan and bonuses to help you achieve your financial goals
  • A commitment from all leadership to help you succeed and develop you within your role
  • Permissive paid time off with six paid company-wide holidays
  • Volunteer time off to give back to your non-profit or charity of choice
  • A thorough and highly rated training program that will provide the knowledge and skills to succeed in your role
  • 401 (k) retirement plan with company match
  • Traditional healthcare benefits such as medical, vision, and dental
  • Supplemental benefits such as life, disability, hospital, critical illness, and pet insurance
  • Unique benefits include mental health and financial wellness programs, LinkedIn Learning, Employee Resource Groups, and leadership development programs
  • An enjoyable online work environment that includes some company-paid lunches and Supplemental Health Care merchandise
  • Opportunity for you to be sent on a luxury, expense-paid vacation and become a member of Supplemental Health Care’s Champions Circle
  • A remote work culture that provides equipment such as a laptop, a computer screen, keyboards, mouse, headset, computer camera, and computer bag

Pay Range: Base Pay between $70,000 and $85,000 plus bonus

Diversity Statement:

We are greater when we are equal. We believe inclusivity is the celebration of multiple experiences, approaches, and points of view. We bring together the best people, provide world class opportunities, and cultivate an environment where we all succeed. Our commitment to inclusion across race, gender, age, religion, identity, and experience drives us forward every day. It fuels our innovation and connects us closer to our clients and the communities we serve.

Equal Opportunity/Affirmative Action Employer – Supplemental Health Care is an Equal Employment Opportunity Employer.

Supplemental Health Care participates in E-Verify to confirm work authorization. Please visit www.uscis.gov for more information.

 

 

 

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