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Job Discription
Prairie States Enterprises, Inc. is a third party administrator, a benefits industry leader, and a trusted advisor to self-insured companies and their employees. We provide a complete range of medical benefit management services, all performed in-house, and to exacting standards of excellence by our professional staff.
We are seeking an experienced clinical supervisor who is looking to contribute to health care as part of our Clinical & Health Services Team. As a supportive role to the VP of Clinical & Health Services, the Clinical & Health Services Supervisor is responsible for supervision of all aspects of Health Management delivery, including preceptorship and mentorship, clinical supervision; clinical staff development; clinical documentation; HS programs evaluation, planning and development; performance improvement; and compliance. Places priority on the core value that employees are our competitive advantage and key to value proposition and service delivery to our members.
This is a full-time position with a hybrid remote work arrangement in our Sheboygan, WI location.
Highlights of Essential Job Functions:
- Assists in the supervision of the Health Services Department staff of Health Management which includes Pre-Certification staff, Utilization Management staff, and Case Management staff.
- Mentors new team members, and is responsible for training, guidance and direction for work assignments. Prepares and maintains accurate audit working papers and files to support audit findings.
- Responsible for auditing internal quality and process initiatives in accordance with contract language and standards of Utilization Management.
- Manages the day-to-day workflow and serves as a primary contact for this workflow.
- Supports the VP of Clinical & Health Services in coverage duties and accreditation assistance.
- Assists in the review of business processes on a standard schedule in order to identify and recommend process improvements that increase efficiency and/or accuracy of claims processing.
- Review and report plan document discrepancies with suggested resolutions to appropriate departments.
Position Requirements:
- Required-BSN RN with unencumbered RN License
- Preferred-MS RN with unencumbered RN License
- 5+ years in hospital or other clinical setting
- 3+ years in Nursing Leadership Roles (Manager, Team-Lead, Charge Nurse, etc.)
- Background in health benefits preferred.
Required Competencies:
- Energetic and enthusiastic team player who works well in a fast-paced dynamic work environment
- Demonstrates the ability to work collaboratively with the Health Management Team, clients, vendors, and all other internal PSE departments
- Demonstrates the ability to work independently and meet required deadlines
- Strong sense of urgency; results and action oriented: able to define goals and metrics, develop actionable plans and manage work to achieve desired outcomes; has a sense of urgency and fosters the same in others
- Adherence and application of HIPPA regulations
To the selected candidate, we offer:
- Competitive compensation based on experience and a comprehensive benefit package provided to include Medical, Dental, Vision, Life, STD/LTD, FSA, Paid Time Off, personal days, 401k with match, wellness and exercise membership and more.
- Opportunity for meaningful career growth within a results-driven company and our company culture is one of ambition, integrity, empowerment, teamwork and a passion for personal and company success.
If this sounds like you and you’re seeking career growth with an exciting new opportunity, please send your cover letter and resume following the instructions for this site.
Prairie States Enterprises
Equal Opportunity Employer
