Location:Remote - USA
As Revecore's Clinical Operations Nurse Supervisor, you will: Be responsible for the supervision of a team of nurses on the Clinical Operations Nurse Consultant Team, including management to optimize the function of the team with focus on quality and efficiency.
The Role:- Provide supervision to team of clinicians that will work to appeal and overturn denials on client claims.
- Provide supervision to Clinical Operations Teams as assigned by Nurse Manager/Director (Team Leads, Clinical Appeal Nurse Consultants, Transplant Analysts, etc.)
- Evaluate revenue cycle operations, including analysis of root causes, identification of areas for process improvement, education of staff, and evaluation of metrics and outcomes to measure success.
- Support Clinical Case Study presentations for clients in collaboration department designees and Client Success personnel.
- Support onboarding/training of new nurse hires both onshore and offshore in collaboration with Revecore Training & Development, Client Success, and offshore vendors.
- Assist the Nurse Manager with the implementation and management of workflow among nurses.
- Support the Quality Assurance program for all Clinical Operations teams in collaboration with the Revecore Quality Assurance Department policy.
- Support the Performance Evaluation process for Clinical Operations, ensuring all applicable deadlines are successfully achieved.
- Support Team Leads to assist nurses with account-related questions related to appeals and denial resolution activities.
- Provide comprehensive updates to the Nurse Manager/Director regarding client communication, updates, issues, and needs.
- Provide the Nurse Manager with information regarding staffing and personnel issues as needed.
- Assist the Nurse Manager in developing, evaluating, and distributing client, payor, and company reports as assigned.
- Support the Nurse Manager and nurses with managing and updating department work plans when applicable.
- Prepare and submit correspondence such as appeal letters, emails, online inquiries, adjustments, reports, and other documents if assigned.
- Assist Nurse Manager to analyze monthly reports by trends, hospital, payor and reason to identify operational issues causing denials.
- Actively collaborate with internal and external teams (vendors, Client Success, Operations, Legal, etc.) to resolve barriers and optimize performance.
- Review managed care contracts, hospital billing statements/bills, and insurance denials as needed to support workflow.
- Support and develop continuing education when the need arises and during scheduled department education initiatives in collaboration with the Team Leads.
- Communicate with hospital and payor personnel concerning issues relating to denials in collaboration with Client Success.
- Present initiatives and results at meetings as requested by Revecore client partners.
- Maintain confidentiality of information in compliance with company policy and HIPAA.
- Maintain regular contact with necessary parties including payors, clients, managers, and other Revecore personnel.
- Attend client, department, and company meetings.
- Comply with federal and state laws, company policies, and procedures.
- Other duties as assigned.
You'll be successful if you have: - Current, valid RN license, BSN and/or advanced degree.
- Revenue cycle experience as it relates to Clinical Operations and Utilization Review areas required.
- Clinical nursing experience working in hospital environment, preferably in ER, ICU, Med-Surg, Psych, and/or Transplant unit.
- Experience with MCG care guidelines and/or InterQual clinical criteria.
- Preferred but not required: Experience with a variety of appeal types, including but not limited to DRG downgrade, Clinical Validation, Large Claim Audit, Transplant, etc.
- Overall hospital operations experience with multi-disciplinary teams.
- Strong computer proficiency, including working knowledge of Electronic Medical Records, Microsoft Word, and Excel.
- Excellent interpersonal and communication skills.
- Experience with performance improvement tools, such as variance/root cause analysis, data interpretation, flow charting, and metric development.
- Mathematical skills -- the ability to calculate rates using addition, subtraction, multiplication, and division.
- Ability to read and interpret an extensive variety of documents, such as contracts, claims, instructions, policies and procedures in written (in English), and diagram form.
- Ability to write routine correspondence (in English).
- Ability to define problems, collect data, establish facts, and draw valid conclusions.
- Strong customer service orientation.
- Strong team player.
- Commitment to company values.
Work at Home Requirements:- A quiet, distraction-free environment to work from in your home.
- A secure home internet connection with speeds >20 Mbps for downloads and >10 Mbps for uploads is required.
- The workspace area accommodates all workstation equipment and related materials and provides adequate surface area to be productive.
Employment is contingent upon eligibility to work in the U.S., employment history verification, and a background check.
Must reside in the United States within one of the states listed below:
Alabama, Arkansas, Florida, Georgia, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Massachusetts Michigan, Minnesota, Mississippi Missouri, Nebraska, New Hampshire North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Vermont, Virginia, West Virginia and Wisconsin
