Clinical Manager

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 nation's military, veterans, Guard and Reserves, and Medicare beneficiaries.
• Working in a continuous performance feedback environment

Minimum Qualifications

• Associate's Degree in Nursing (ASN) or Bachelor's 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).

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 workforce-both current and future-to 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.

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