Clinical Support Team Lead - Capital Blue Cross

Position Description

he Clinical Support Team Lead is responsible for staff oversight including staff productivity, distribution of work and administrative tasks related to department functions. Provides administrative support to our clinical staff. The Clinical Support Team Lead will monitor the quality of work, oversee operational reports, and ensure timely case notification as per regulatory requirements.

Responsibilities and Qualifications

Duties and Responsibilities:

• Supervise the clinical support specialist team to ensure all notification requests are completed timely and accurately.
• Set goals, deliver coaching, and evaluate the performance of all direct reports.
• Ensure training of staff, develop and maintain written training materials and procedures.
• Educate team as new procedures are developed, review procedures with staff as needed and monitor staff to ensure that procedures are implemented and adopted as standard practice.
• Resolve escalated/time sensitive notification requests.
• Support root-cause analysis related to trends observed from compliance and audit data to identify areas for process improvement and education.
• Support the Manager, Clinical Support with satisfying requests relating to member/provider notifications during regulatory audits.
• Demonstrate and maintain a positive and open-minded demeanor and welcoming approach when engaging with team members and internal partners.
• Complete quality monitoring through case audits and workflow oversight.
• Ensure daily operational compliance reports are reviewed timely and accurately, immediately escalating any issues.
• Ability to adapt to constantly changing priorities. Includes ability to work with minimal supervision and to inspire teamwork among diverse groups.
• Perform other duties as necessary

Skills:

• Leadership: Demonstrated supervisory, coaching, and training skills. Ability to work collaboratively and effectively across multiple departments.
• Strong organizational/time management skills and multi-tasking abilities. Detail-oriented with the ability to conduct research. Attention to detail is critical. Excellent verbal and written communication skills. Ability to demonstrate excellent English language proficiency skills and put skills into practice: spelling, grammar, punctuation. Ability to manage own work, multi-task, and prioritize. Highly organized, deadline oriented, and quality focused. Provides special project assistance as needed. Ability to work collaboratively and effectively across multiple departments. Basic to intermediate proficiency with Microsoft Office Suite. Advanced problem-solving and structured analysis/design techniques. Includes the ability to understand complex inter-related systems and to independently resolve business and technical problems encountered.

Knowledge:

• Knowledge: Demonstrated knowledge of the utilization review notification process.
• Preferred knowledge of the health care industry. Includes knowledge of standards, policies, and familiarity with business practices and procedures for business unit.
• Knowledge of regulatory and accreditation standards and requirements preferred. (e.g., NCQA, URAC, Pennsylvania Department of Health and Department of Insurance, ERISA, Act 68). Working knowledge of the insurance industry, health plan benefits and product lines (e.g., PPO, POS, HMO, FEP, Senior Products, Traditional/Comprehensive). Preferred experience in a managed care organization with specific experience related to clinical management.

Experience:

• Experience: Minimum of 3+ years of experience within utilization review with direct experience with member/provider notification process.

Education and Certifications:

• Possesses a high school diploma or G.E. D. with 4 to 6 years’ experience in the medical health field (e.g., medical assistant, medical secretary) or 3 to 5 years’ experience in a managed care clinical department. Working knowledge of medical terminology. Preferred bachelor’s degree in business administration, Health Planning and Administration, Information Systems, Computer Science or a related field. Continued higher education is strongly recommended.

Work Environment:

Work Environment: work is typically performed in an office setting.

About Us

We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a diverse and caring team of supportive colleagues, and be encouraged to volunteer in your community.  We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career.     And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.