Manager, Clinical Call Center Operations - Must be RN

Job Summary:

The Manager, Clinical Call Center Operations is responsible for coordinating and leading inbound and outbound call center activities to achieve compliance with AAACN, URAC, NCQA, and regulatory standards.

Essential Functions:

• Guide team leaders on effective people management strategies such as staffing, coaching and mentoring to maintain a high level of department morale, operational efficiency and delivering an exemplary customer experience
• Collaborate with work force management team to provide optimal staffing and ongoing monitoring of the staffing model
• Assist in the development of department policies, procedures and call management processes
• Collaborate with other organizational departments on integration of cross departmental processes to achieve optimal efficiencies
• Prepare and present data and regulatory compliance reports to stakeholders and leadership team
• Monitor and approve regulatory reports
• Assist senior leadership with member and staff related concerns
• Promote operational excellence through process monitoring, improvement, and change management
• Identify departmental opportunities and develop effective solutions to enhance efficiency, effectiveness, and service delivery
• Coordinate department specific orientation and continuing education
• Collaborate with Workforce Management Team in monitoring service levels and analyze for trends
• Oversee departmental Clinical Quality Team Clinical Quality Improvement activities
• Act as a resource to employees and provide clinical, technical and procedural guidance
• Provide support for staff and leadership to ensure 24/7 coverage of operations, including on-call responsibilities, business continuity activation, timely responses to state generated inquiries, and staffing situations 
• Monitor and analyze call data and provide input to leadership to improve service quality and operational efficiency
• Ensure compliance with healthcare regulations and compliance standards relevant to various markets and the nurse advice lines metrics
• Perform any other job duties as requested

Education and Experience:

• Registered Nurse is required
• Bachelor’s degree or equivalent years of work experience is required, BSN is preferred
• Minimum of five (5) years of clinical experience is required
• Minimum of three (3) years progressive’ management experience is required
• Call center or Telephone Triage experience is required
• Managed care experience is highly preferred

Competencies, Knowledge and Skills:

• Superior Nursing Process Skills
• Strong understanding of nursing practices, medical terminology, and crisis management.
• Strong clinical leadership experience/skills
• Data analysis and trending
• Critical listening and thinking skills
• Training and teaching skills
• Time management skills
• Strong Word, Excel, and PowerPoint experience required; intermediate level experience preferred
• Exceptional written and verbal communication skills
• Strong critical thinking, decision making and problem solving skills
• Strong Customer service orientation
• Ability to develop, prioritize and accomplish goals
• Strong organizational skills to manage multiple tasks, schedules, and priorities effectively.
• Ability to adapt to changing circumstances, including evolving healthcare practices and regulations.

Licensure and Certification:

• Current, unrestricted Registered Nurse (RN) license in state or practice is required
• Ability to obtain licenses in multiple states in which CareSource serves members

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• May be required to work non-traditional hours to fulfill essential functions of the position because the department operates 24/7/365

Compensation Range:

$81,400.00 - $130,200.00

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Salary

Organization Level Competencies

• Create an Inclusive Environment

• Cultivate Partnerships