Supervisor of Health Services - Madison - WPS Inc

    WPS Inc
    WPS Inc Madison

    4 days ago

    Description
    Role SnapshotOur Health Services Supervisor is responsible for overseeing the Health Services Utilization and Case Management nursing teams. This supervisor will manage inventory, support staff mentoring and training, and drive workflow efficiencies within the teams. Will Work closely with the Health Services Manager, and support implementation of departmental and company initiatives while serving as a key daily resource for the nursing teams.
    Salary Range$95,000 ~ $115,000The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, and experience.
    Work LocationWe are open to remote work in the following approved states:Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, Ohio, South Carolina, Texas, Virginia, Wisconsin
    **Employees living within 45 miles of WPS Headquarters (1717 W. Broadway in Madison, WI) will be expected to be able to work onsite 2 days a week on a regular basis.How do I know this opportunity is right for me? If you:
    • Can ensure utilization management reviews are completed in accordance with department standards.
    • Enjoy coaching and mentoring nursing staff conducting medical necessity reviews, prior authorizations, and appeals.
    • Have overseen case management activities to ensure timely and appropriate member interventions to meet individual needs and maximize health outcomes.
    • Can collaborate with physicians, providers, and internal departments to coordinate care for complex cases.
    • Would enjoy monitoring team performance, productivity, quality of care and compliance with established metrics and accreditation standards (e.g., URAC, NCQA).
    • Like providing training and professional development opportunities for nursing staff.
    • Can serve as a clinical resource for staff, handling escalated provider and member inquiries.
    • Would like to conduct staff quality audits and support the development of clinical guidelines and utilization review protocols.
    • Have participated in quality improvement initiatives and contribute to the development of department goals and performance targets.
    • Would be able to assist with system testing, configuration, training, and implementation of new systems or upgrades.
    Minimum Qualifications
    • Registered Nurse (RN) with current licensure in the state of Wisconsin OR current Compact License.
    • Active RN license, applicable to state of practice in good standing.
    • Associates Degree in Nursing.
    • 5 or more years of clinical experience in a healthcare setting (hospital, clinic, home care, skilled nursing facility, etc.)
    • Solid knowledge and understanding of medical/clinical review processes.
    • Strong analytical, problem-solving, and organizational skills with the ability to manage multiple cases simultaneously and meet strict deadlines this includes:
      • 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
    • 1 or more years of experience in a supervisory or leadership role.
    • Bachelor's degree in nursing (BSN).
    • Certified Managed Care Nurse (CMCN).
    • Health insurance background that could include, Third party Administration (TPA) Point of Service (POS), Preferred Provider Organization (PPO), or Medicare Supplement) plans.
    Remote Work Requirements
    • High speed cable or fiber internet
    • Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at )
    • 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: )
    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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    Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
    This employer is required to notify all applicants of their rights pursuant to federal employment laws.

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