**FIND YOUR FUTURE** We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and commitment to diversity and inclusion. **Overview** The Clinical Supervisor will be responsible for assisting the clinical leadership in the day-to-day management of the RN staff of their assigned area (Case Management, Utilization Review and Population Health). This will include monitoring the daily assignments, daily report activity and workflow of the team to include all review processes, ensuring adherence to regulatory compliance requirements. The Clinical Supervisor will provide support and act as a subject matter expert in that functional area to their team to ensure adherence to department compliance, productivity, and quality goals. They shall function to promote teamwork and accountability in a performance-based work environment and represent the department on cross-functional teams when necessary. Duties will include, but are not limited to, monitoring workflow, mentoring and managing associate issues for assigned team members. The Clinical Supervisor will be directly responsible for the support and overall performance of their team members as well as ongoing support of corporate initiatives, values, and vision. The Clinical Supervisor will also have responsibilities that support the improvement and growth of the entire strategic business unit. These responsibilities will include the delivery of data analysis and reporting, audits, staffing models, education and training initiatives, performance standards, and policies/procedures that align with the core components of the client centric delivery model. **Qualifications** + Registered Nurse (RN) with active, current, unrestricted NYS license required. Associates degree in nursing required. BSN preferred. + Four (4) years of clinical experience required to include clinical experience in CM/UM. Experience with a health insurance company preferred. + One (1) year of progressive leadership experience/responsibilities required. + Based on functional area, case management certification (CCM) will be required within three (3) years of supervising case managers. + Clinical knowledge of the health or social needs for the population served. + Clinical experience in at least one of the following preferred: Behavior Health, Transplant, Neo-Natal, or Oncology. + Ability to identify barriers to a successful care management path. + Ability to interact effectively with physicians and other members of the health care team. + Proficient PC and Windows skills required, including MS Office. + Excellent problem-solving abilities, coupled with solid time management skills. + Excellent written, verbal, and interpersonal communication skills. + Transferable knowledge, skill, and ability to complete job duties independently and proficiently. Flexibility in work schedules and assignments. + Ability to assume responsibility and maintain confidentiality. + Proven examples of displaying the Nova values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable. **Essential Accountabilities** + Clinical Supervision + Assess the patient’s broad spectrum of immediate and long-term needs through evaluation of the patient’s social and medical history. + Develop a plan of care with the providers of care and patient, considering physical and psychosocial needs, the benefit plan and cost benefit analysis factors which impact the patient’s optimal recovery. + Continuously evaluate the plan of care based on the changing needs of the patient and monitor the quality of care and effectiveness of care being provided for all involved members of the inter disciplinary team. + Ensure compliance with regulatory and privacy standards, prompt payment/reimbursement and appeal process as indicated; coordinate the decision and documentation process; maintain a current and accurate database. + Provide high quality, professional utilization management services: (medical necessity review for Prior Authorization, pre-certification, and concurrent review). + Prompt, courteous, and error free in performing utilization management functions. + Maintain quality of reviews and documentation by demonstrating sound judgment, excellent analytical and communication skills with attention to detail, utilizing designated criteria and/or IH policy as required. + Complete requests in compliance with designated turnaround time. + Clear documentation of clinical information for medical necessity review of all requests, procedures, admissions, and concurrent review. + Accurate documentation of criteria, policy, or AMD review in case notes. + Complete and timely follow through for disposition of cases – MD reviews, chart reviews, audits, case management referrals, etc. + Establish professional working relationships with all members of the interdisciplinary team and communicate case objectives to the appropriate involved parties. + Act as a patient advocate understanding and identifying potential for complications, understanding methods for assessing the current and future physical and psychosocial characteristics of illnesses. + Assist patients in navigating the health care system. Coordinate Specialty care, follow-up on test results and other care coordination needs + Read, understand and apply principals of the American with Disabilities Act and understand federal legislation affecting individuals with disabilities. + Be knowledgeable of assistive and adaptive equipment. + Establish available support systems and be versed in methods of researching and interviewing community resources to assist the patient in achieving maximum psychological, social, and physical recovery. + Ability to effectively communicate to the patient the available services and resources applicable to the patients immediate and future needs. Assist the patient in obtaining these services. + Ability to identify cases that would benefit from alternative care through assessment and evaluation of the patient’s needs, as well as available resources. + Work closely with the payer, providers, and all involved team members in evaluating the quality and cost effectiveness of services. Negotiate cost discounts when appropriate. + Identify cases that would benefit from alternative levels of care and resources (i.e., rehabilitation facilities and home health care providers). Implement alternatives to existing care, considering quality of care and the patient’s current and ongoing needs. + Understand case management concepts such as roles, philosophies, principals, liability, and confidentiality issues. Apply these concepts in developing appropriate plan of care and goals based on the needs of the patient. + Utilize behavioral strategies to help patients adopt healthy behaviors and improve self-care in chronic disease management. Promote self-management goals. + Be knowledgeable in applying problem solving techniques to the care management process. Analyze and evaluate outcomes and implement alternatives when appropriate. + Document the patient’s plan of care in a timely manner. + Ongoing evaluation and documentation of patient progress/risk status. + Maintain a professional status within the community through membership in professional organizations and/or participation in continuing education. + Participate in Nova’s training and education committees as assigned and perform all assignments in a professional manner. + Support staff education and development, including oversight of implementation of staff orientation and training. + Obtain case manager input on support staff training and performance. + Direct staff to access training, clinical and professional development resources available on SharePoint. + Be knowledgeable of the scope of practice of their state(s) licensure and practice accordingly. + Continuously seek, identify, and implement process improvement strategies to increase and improve departmental performance. + Experience in the research, development and implementation of clinical best practice and analysis of outcome measures. + Proven examples of displaying the Nova values: Passion, Caring, Collaborative, Respectful and Accountable. + Leadership + Lead business unit staff. + Maintain departmental and individual goals. + Coach, mentor, and direct staff to achieve optimal level of accuracy and production to meet departmental standards for quality and turn-around time. + Provide regular feedback to staff on performance related to individual competencies against individual and department goals. + Lead departmental meetings and maintain a work environment that promotes teamwork and is customer oriented. + Work with team to establish and implement product and/or program strategies that integrate wellness with utilization, case, and disease management. + Maintain current technical and working knowledge of client contracts, benefits, systems, policies and procedures. + Collaborate with clients, brokers, vendors, and operations team members in support of department goals. + Develop and implement metrics to track and monitor programs, workflows, and productivity. + Serve as a resource to and collaborate with other functional areas that interface with medical management including vendors, claims, provider relations, corporate analytics, quality, and other departments on matters related to medical management. + Ensure the development and documentation of department policies and procedures. + Develop and implement the department’s Quality Assurance plan. + Use and maintain staffing models to forecast department resource needs. _Immigration or work visa sponsorship will not be provided for this position_ Hiring Compensation Range: $82,500 - $95,000 annually _Compensation may vary based on factors including but not limited to skills, education, location and experience._ In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future. _As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant’s race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law._ _Click here (http://www.independenthealth.com/about/careers/additional-eeo-aap-information)_ _for additional EEO/AAP_ _or Reasonable Accommodation_ _information._ Current Associates must apply internally via the Job Hub app. The Independent Health Family of Companies, headquartered in Buffalo, NY, serves nearly 400,000 members and provides innovative health care products and benefits designed to engage consumers in their health and well-being. Established in 1980, our comprehensive portfolio includes Pharmacy Benefit Dimensions, Reliance Rx, Nova Healthcare Administrators, Care for You and the Independent Health Foundation. Our culture sets us apart. Our core values drive who we are and the work we do. As a member of our family, you’re part of something special, in your work and in the community. We understand and appreciate that everyone has unique experiences, perspectives and identities which is why we pledge to create a safe space where all people and ideas are welcomed. We are here to continue learning and to generate important dialog. We are committed to doing what matters most - reaching out, working together, and caring for our community. A healthy community benefits everyone who lives in it. You too can be part of making difference in the lives of others, together we achieve so much more. Please click here (http://www.independenthealth.com/about/community-report) to view our Community Reports. **Apply today and join us on the journey to a happier, healthier, and more inclusive community.** We are a drug-free workplace. We are committed to providing reasonable accommodations for qualified individuals with disabilities and disabled veterans. An applicant for employment in need of an accommodation to participate in the application and recruitment process should contact Human Resources at: accommodations@independenthealth.com or Human Resources, 511 Farber Lakes Drive, Williamsville, NY 14221. _Please note, we do not accept unsolicited resumes. We do not accept resumes from headhunters, placement agencies, or other suppliers that have not signed a formal agreement with us._