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WellSky · 22 hours ago

Team Lead, Authorization Management Clinical Reviewer

United States

Full-time

Remote

Mid Level

4+ years exp

WellSky is where independent thinking and collaboration come together to create an authentic culture. This role is responsible for overseeing a team that coordinates and delivers care to patients as part of payer programs authorized by their health insurance provider, focusing on operational and management oversight.

Health CareSoftware

Responsibilities

Oversee daily operations of clinical operation support staff and ensure tasks are completed efficiently and accurately

Serve as the primary point of contact for team communications by promoting collaboration and resolving minor operational challenges

Assist in the development and execution of work plans, assign tasks, and monitor completion to meet team goals

Provide direct support and guidance to team members, including on-the-job training and resource allocation

Ensure compliance with organizational policies and maintain accurate documentation of team activities

Monitor team performance metrics to identify areas for improvement and ensure quality service delivery

Perform other job duties as assigned

Qualification

Active RN LicenseClinical acute nursingUtilization management experienceBachelor's Degree in NursingInterQual guidelinesCarePort Care ManagementMicrosoft OfficeCommunication skillsCritical thinkingProblem solvingOrganizational skills

Required

Bachelor's Degree or equivalent work experience

0-1 years of relevant management work experience

At least 4-6 years relevant work experience

Active RN License

2 years clinical acute nursing experience

1-2 years of hospital-based utilization management experience

Preferred

Bachelor's Degree in Nursing

Denials and Appeals experience

Experience with managed care and CMS standards

Proficient in the use of window-based computer programs

Excellent verbal, written, and interpersonal communication skills

Critical thinking skills, creative problem solving, and proficient organization and planning skills

Experience with InterQual guidelines for acute-care and/or other clinical decision support tools, especially in utilization management and prior authorization processes

Experience with CarePort Care Management