PacificSource Health Plans · 17 hours ago
Clinical Team Leader, Special Functions
Boise, ID
Full-time
Onsite
Senior Level
$83K/yr - $137K/yr
5+ years expPacificSource Health Plans is dedicated to helping members access quality, affordable care. The Clinical Team Leader, Special Functions is responsible for managing Special Functions staff, overseeing program development, and ensuring the quality and productivity of team tasks while providing leadership and support to team members.
CommunitiesCustomer ServiceNon Profit
Responsibilities
Take a leadership role in the development, implementation, and ongoing operation and maintenance of assigned programs, services, or functions
Improve the performance of the department through effective oversight and coaching of team members, managing team performance and improving processes and outcomes. Monitor daily workflow and caseloads and other work processes of team to assure appropriate distribution and processing of tasks
Responsible for the orientation and training of new hires
Provide ongoing supervision, training, evaluation, and leadership to assigned team members. This may include annual reviews, involvement in promotions and/or terminations of employees
Participate in hiring decisions in concert with Medical Services Director and/or Medical Services Manager and HR
Monitor and evaluate team assignments relating to volumes, timelines, accuracy, customer service, and other quality and performance measures, and take actions as appropriate
Assist with process improvement and work with other departments to improve interdepartmental processes. Utilize lean methodologies for continuous improvement. Utilize visual boards to monitor key performance indicators and identify improvement opportunities
Serve as liaison with other PacificSource departments or community partners to coordinate optimal provision of service and information. Serve on various internal and external committees as required or designated. Document and report any pertinent communications back to the team or department
Utilize and promote use of evidence-based medical criteria
Maintain modified caseload consistent with assigned responsibilities
Facilitate investigation and resolution of process-related issues as needed. Facilitate conflict resolution, including interfacing with affected departments and individuals, as appropriate
Oversee and assist in providing exceptional service and information to members, providers, employers, agents, and other external and internal customers
Provide backup to other departmental teams or management staff, as needed
Meet department and company performance and attendance expectations
Relate new or revised policies, procedures and/or processes to team members to ensure they have the most up‐to‐date and current information
Facilitate team operations by discussions through the sharing of information and knowledge, identification of teamwork issues, development of problem‐solving recommendations, and recommendations of standardizing Health Services operations
Represent the Heath Services Department, both internally and externally, as requested by Health Services Manager and/or Director
Perform other duties as assigned
Qualification
Required
A minimum of five years clinical experience required
Registered Nurse/Licensed Social Worker with current appropriate unrestricted state license
Strong analytical and organizational skills with experience in using information systems and computer applications
Ability to develop, review, and evaluate utilization management reports
Strong computer skills including experience with Word, Excel, and PowerPoint
Ability to work independently with minimal supervision
Effective adult education/teaching and/or group leadership skills
Knowledge of health insurance and state mandated benefits
Knowledge and understanding of medical procedures, diagnoses, care modalities, procedure codes, including current versions of ICD, DSM, and CPT Codes
Thorough knowledge and understanding of contractual benefits and options available outside contractual benefits
Accountable leadership, Collaboration, Communication (written/verbal), Critical Thinking, Decision Making, Influencing, Listening (active), Organizational skills/Planning and Organization
Preferred
Minimum of three years direct health plan experience in the following areas: utilization management, grievance and appeal, and claims review strongly preferred
Prior supervisory experience preferred
Case Manager Certification as accredited by CCMC preferred
Company
PacificSource Health Plans
Founded in 1933, PacificSource is a not-for-profit health insurer for people and organizations throughout the Northwest.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
John Espinola MD MBA
President and CEO
Erick Doolen
Chief Operating Officer
Recent News
2025-11-29
2025-10-22
Company data provided by crunchbase