Responsibilities:
Team Leadership & Management
- Supervise daily operations of the team, ensuring productivity and accuracy targets are met.
- Monitor progress and manage team schedules to meet turnaround times (TATs).
- Conduct regular coaching, one-on-one sessions, and performance reviews.
- Foster a positive, collaborative, and results-oriented work environment.
Peer to Peer Processing & Quality Assurance
- Review and approve complex or high-level account before submission.
- Ensure all appeals are handled in accordance with company procedures and compliance standards.
- Monitor key performance indicators (KPIs) and quality metrics, identifying opportunities for improvement.
- Implement corrective action plans to address performance or quality gaps
Required Qualifications:
- Bachelor of Science in Nursing with active US license in at least one US mainland state
- 1 yr of leadership/TL exp in clinical setting
- Must be flexible with work schedule
- Prior utilization management experience preferred
