Supervisor - Clinical Operations, Nurse

Requirements

• Duties and Responsibilities:
• Owns and oversees day-to-day process across the organization for their specific workstream, and ensures staff compliance with program workflows, clinical documentation, benefit resource allocation, and work distribution.
• Responsible for oversight of complex or escalated case investigations and notifies department leadership as appropriate.
• Coordinates department workload and identifies staffing needs or other resources to meet quality, quantity, and departmental goals. Communicates changes in departmental processes and procedures to staff when necessary.
• Serves as primary contact for staff, assigned internal and external programs and escalated issues. Identifies potential process improvement opportunities across departments and makes recommendations to leadership as appropriate.
• Audits staff processes and reviews cases with staff to assess compliance with established clinical and clinical support guidelines, workflows, and adherence to benefits structure and applicable regulations. Consults with the leadership regarding complex and/or high-profile cases.
• Recommends promotion, termination, hiring or reassignment of subordinates including scheduling and conducting informal and formal employee performance reviews, coaching and competency assessments.
• Develops, implements, and maintains internal policies and procedures.
• Coordinates department project planning to accommodate the company's annual business needs. Works with management team to develop future programs and goals.
• Collaborates with clinical staff and Medical Director regarding medical cases to ensure services are clinically appropriate.
• Assists with development of department training materials. Identifies educational opportunities for the staff. Collaborates with Clinical Operations Division educator to provide educational opportunities.
• Uses performance metrics and data analysis to identify trends, drive continuous improvement, and improve outcomes.
• Knowledge, Skills, and Abilities:
• Requires a bachelor's degree in clinical field for which the team has responsibility. (Example: Nursing teams would need a BSN)
• Associates degree in a related health field may be considered with 5 years of experience
• Active/Good standing RN license, including accountability for maintaining all requirements of licensing post hire, must be eligible to be licensed in all US states and territories.
• 1-3 years leadership experience
• Demonstrates excellent verbal and written communications skills.
• Shows strong collaboration skills and the ability to build productive working relationships.
• Displays a high level of self-initiative and independent problem-solving skills.
• Preferred:
• Nursing experience in Fertility, Obstetri cs, Labor, and Postpartum care.
• Case Management experience is preferred
• Work-at-home requirements
• Must have the ability to provide a non-cellular High Speed Internet Service such as Fiber, DSL, or cable Modems for a home office.
• A minimum standard speed for optimal performance of 30x5 (30mpbs download x 5mpbs upload) is required.
• Latency (ping) response time lower than 80 ms
• Hotspots, satellite and wireless internet service is NOT allowed for this role.
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
• How we value you
• Competitive pay/salary ranges
• Incentive plan
• Health/Vision/Dental benefits effective day one
• 401(k) retirement plan: company match - dollar for dollar up to 4% employee contribution (pretax or Roth options) plus a 6% annual company cont

Benefits

Additional Information

Government Employees Health Association, Inc. (G.E.H.A) is a nonprofit member association that provides health and dental benefits that millions of federal employees and retirees, military retirees and their families have counted on since 1937. Offering one of the largest health and dental benefit provider networks available to federal employees in the United States, G.E.H.A empowers health and wellness by meeting its members where they are, when they need care. G.E.H.A has one mission: To empower federal workers to be healthy and well. The Supervisor leads and has oversight of day-to-day operations with full accountability for team performance, outcomes, and regulatory compliance. Responsible for supervising daily operations, serving as the primary contact for clinical (licensed) and non-clinical (non-licensed) staff. Directly supports clinical teams through clinical and operational decision-making, evidence-based practice, and medical expertise. Partners with leadership to develop, implement, and maintain policies, procedures, and workflows to ensure regulatory and organizational compliance.

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