Supervisor, Clinical Quality Management

Job Summary

The position is responsible for supervising Clinical Quality Management (CQM) staff production and quality processes; assisting in the development of policies and procedures related to CQM; meeting CQM contractual requirements; and ensuring compliance with URAC standards. The Supervisor oversees clinical and non-clinical staff supporting CQM programs by overseeing and providing training and onboarding of new staff; determining work assignments; performing audits for clinical records and / or work accuracy; and ensuring effective, consistent and accurate workflow. The position also assists the Manager in developing study topics, quality improvement processes and reporting in support of the CQM program.

Education & Experience

Required :

• RN or LCSW (Independently Licensed Clinical Social Worker) with current unrestricted license in appropriate state or territory of the United States
• If supporting TRICARE contract, must be a U.S. Citizen
• If supporting TRICARE contract, must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation
• 5+ years of clinical experience in a variety of settings (behavioral health and medical / surgical)
• 2+ years of supervisory experience
• 1+ year of experience in Quality Management to include conducting medical records abstracting and quality investigations

Preferred :

Key Responsibilities

Competencies

Coaching / Training / Mentoring : Actively foster actions required for desired business outcomes through ongoing constructive feedback.

Communication / People Skills : Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate.

Computer Literacy : Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications.

Coping / Flexibility : Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach is required.

Delegation Skills : Provide clear performance expectations for projects and ensure adequate access to resources for completion.

Organizational Skills : Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented.

Problem Solving / Analysis : Ability to solve problems through systematic analysis of processes with sound judgment; Has a realistic understanding of relevant issues.

Team-Building / Team Player : Influence the actions and opinions of others in a positive direction and build group commitment.

Technical Skills : Comprehensive knowledge of research methodology; proficient applying appropriate data analysis processes; knowledge of managed care principles and methods; knowledge in the application of clinical criteria; proficient with Microsoft Word, Excel, and PowerPoint.

Working Conditions

Working Conditions :