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Job Discription
Description
* Position is eligible for Remote / Work from Home opportunity *
Department: DME Med Review
Telecommuting Eligible: Yes
Job Grade: E13
Job Title
Department: DME Med Review
Telecommuting Eligible: Yes
Job Grade: E13
Job Title
Supervisor Medical Review
Job Summary
The Supervisor Medical Review (MR) provides guidance, leadership, planning, and reporting to appropriate individuals. This position supervises clinical staff to ensure the business unit is administering the organizations contracts with the best possible service while maintaining contract expectations and within budget constraints while optimizing staffing levels.
Key Performance Indicators
- Ability to lead and develop staff
- Excellent coaching and training abilities
- Ensures MR goals are met
Essential Functions
Key Duties/Responsibilities/Accountabilities
- Ensures the organization meets contractual obligations and performance standards including meeting or exceeding Contractor Performance Evaluation (CPE) standards in coordinating workloads for a multiple state contractor while operating within the Medicare and corporate budgets
- Maintains a strong technical understanding of the systems used to manage Medicare business and the interrelationships between teams and system usage
- Serves as a resource point for internal/external customers
- Serves as a primary contact to the Centers for Medicare & Medicaid Services (CMS) and other external contact on Medicare operations
- Maintains knowledge of the Statement of Work (SOW) for MR including operational work, reporting, and deliverables
- Coaches and develops clinical and frontline staff by encouraging growth and ensuring staff are meeting performance expectations
- Initiates disciplinary action when performance does not meet expectations
- Leads by example by promoting team work, recognition, and leadership while demonstrating company values
- Responds to and implements change in a flexible, positive manner
- Participates as the area subject-matter expert to support responsiveness to our customers (CMS, providers/suppliers, other teams within the organization, and its employees) as needed
- Communicates accurate, concise information internally and externally
- Participates in budget process for area
- May perform medical review work in support of employees when work load is high
- Operates within and maintains knowledge of the MR budget
Non-Essential Duties and Functions
- Other duties as assigned
Minimum Qualifications
- Associate Registered Nurse degree (ASN) with either an active Registered Nurse license OR Certified Professional Coder (CPC) certification (Dependent upon department needs)
- 2 years’ clinical experience of which 1 year is in the general area of medical/utilization review
Preferred Qualifications
Above requirements and the following:
- Bachelor of Science in Nursing (BSN) degree or willingness to obtain a BSN within 2 years
- Active Registered Nurse License
- Knowledge of Medicare Rules and Regulations
- Strong written and verbal communication skills
- Strong PC Skills
- Ability to build effective interpersonal relationships within the workplace
- Ability to motivate and manage a large group of people
- Ability to direct and maintain a productive and conducive working environment
- Ability to coordinate activities among team
- Ability to problem solve and develop problem solving skills within staff and oneself
- Strong analytical skills and attention to detail
Environment and Cognitive/Physical Demands
- Office Environment
- Ability to read, hear, speak, keyboard, reason, communicate effectively and problem solve
- Requires prolonged sitting and telephone use
- Requires the use of office equipment such as computer terminals, telephones, copiers and printers
- Infrequent lifting to 15 pounds
- Infrequent stooping
- Travel up to 25%
Segregation of Duties
Every employee is responsible to perform their duties and responsibilities in accordance with Noridian values, policies and procedures, including but not limited to: Segregation of Duties Principles, HIPAA, Security and Privacy, CMS requirements, the Noridian Compliance Program and any other applicable laws, rules and regulations.
Statement of Other Duties
This document describes the essential functions, requirements, and responsibilities of this job, and is not intended to be a complete list of all tasks and functions. Employees may be requested to perform job related tasks other than those specifically listed in this description and may be required to perform any task requested by the supervisor or management.
Total Rewards Package:
Health, Dental and Vision Insurance, Voluntary Insurance Plans, Health Savings and Flexible Spending Accounts, 401k and Company Match, Company-paid Life Insurance, Education Assistance Program, Paid Sick Leave, Paid Holidays, Increasing PTO Accrual Plan, Medical/Parental/Disability Leave, Workers Compensation, Retiree Benefits, Severance Package, Employee Assistance Program, Financial and Health Wellness Benefits, Casual Dress, Open Office Setting, and Online Learning System.
CMS Access Compliance and Regulation Contingency Statement
Some positions require compliance with (i) federal and agency specific regulations and related clauses included in Noridian’s prime contracts with the Government, (ii) background checks, and (iii) eligibility for a government-issued identification card.
Equal Employment Opportunity
Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities as well as Sexual Orientation or Gender Identity.
Other Information
Noridian is a Federal Contractor required to comply with the Executive Order 14042 and the guidance released by the Safer Federal Workforce Task Force. This Order requires us to ensure all employees working on covered contracts are vaccinated against COVID-19 unless approved for an accommodation due to a medical condition or a sincerely held religious belief. All candidates must be fully vaccinated upon their start date or have an approved accommodation. To request an accommodation, please contact our Human Resources department at [email protected].
As of December 7, 2021 the nationwide Federal Mandate has been put on hold. At this time, candidates would not be required to be vaccinated or have an approved accommodation, however if the Executive Order 14042 / Federal Mandate is deemed Legal by court rulings, candidates and employees would need to comply.
NOTICE TO COLORADO APPLICANTS:
Per Colorado’s Equal Pay Transparency Rules Act, below is the salary range for potential new hires that will be working/residing in the state of Colorado.
Colorado Salary Range: $66,921.22 – $110,067.50
Other Compensation: Supervisor Incentive Plan
Lifestyle Benefit: $50/month
This job will be closed 10/14/2022 at 8:00AM CST. No further applications will be considered.
Qualifications
Licenses & Certifications
Cert Professional Coder (required)
Registered Nurse (required)
Registered Nurse (required)
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)
Equal Opportunity Employer of Minorities, Females, Protected Veterans and Individual with Disabilities, as well as Sexual Orientation or Gender Identity.
