Manager of Clinical Services

Who We Are

is a leading not-for-profit health insurer and federal government contractor headquartered in Wisconsin. WPS offers health insurance plans for individuals, families, seniors, and group health plans for small to large businesses. We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad. WPS Health Solutions has been making health care easier for the people we serve for more than . Proud to be military and veteran ready.

Culture Drives Our Success

WPS' Culture is where the great work and innovations of our people are seen, fueled, and rewarded. We accomplish this by creating an inclusive and empowering employee experience. We recognize the benefits of Diversity, Equity, and Inclusion as an investment in our workforce-both current and future-to effectively seek, leverage, and include diverse perspectives that fuel agility and innovation on high-performing teams. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities.

From 2021 to 2024, WPS Health Solutions was recognized for several awards:

Role Snapshot

Our Manager of Clinical Services will oversee a team of 3 to 6 nurses focused on medical management. You will get play a pivotal leadership role using your extensive utilization management experience to providing utilization program oversight that includes; development, implementation and maintenance of policies and procedures. This Medical Management Nursing team is highly specialized and work successfully in a remote setting.

How do I know this opportunity is right for me? If you:

• Possess strong critical thinking skills, are comfortable with change and ambiguity in an evolving and progressive department focused on reengineering the way we work.
• Enjoy leading a team of nurses and understand how metrics and process improvement can help improve overall productivity of our team and ensuring timely completion of prior authorization requests.
• Want to work closely with intake supervisor to monitor department needs and volume of incoming requests.
• Like to keep an eye on industry trends and data that can impact productivity and timeliness and are able to implement solutions, if necessary.
• Enjoy consulting with account management teams to collaborate with ASO groups and their membership needs.
• Have overseen Inter Rater Reliability and other mandated staff training.
• Have extensive knowledge and expertise with Milliman Care Guidelines (MCG)(or other industry guidelines) and internal medical policy to provide support to staff and consult internally as needed.
• Can track and monitor nursing license renewals, business license reviews and other system access required to maintain compliance and controls.
• Have experience guiding staff to maintain URAC standards and accreditation, while overseeing and maintaining audit history.
• Enjoy leading and helping teams grow and have a history of making decisions independently without guidance.

What will I gain from this role?

• Leadership experience in a thriving environment focused on integrity, Kindness, Authenticity, and Imagination.
• Experience working with and collaborating with medical directors and quality team to apply medical policy in hour Health Insurance line of Business.
• Technical leadership and oversight in collaborating with internal teams to change workflows, make software changes in Aerial.
• Experience working in an environment that serves our nation's military, veterans, Guard and Reserves, and Medicare beneficiaries.
• Working in a continuous performance feedback environment
• Enjoying a work from home position with daytime hours, no on-call work, no rubber gloves, no travel, and holidays off.

Minimum Qualifications

• Bachelor's degree in related field or equivalent post high school and/or related work experience
• 3 or more years of related work and/or leadership experience.
• Active RN license, applicable to state of practice.

Preferred Qualifications

• 4 or more years of experience in clinical nursing.
• Experience leading a team of 5 or more members successfully in-person or remotely.
• Experience working in a Healthcare Payer environment.
• Strong computer skills including:
  
  
  
  • Ability to utilize multiple screens and learn new applications with ease.
  • Intermediate knowledge in MS Word and MS Excel (creating, sorting, and filtering spreadsheets).
  • OnBase and other programs, as needed.
  
  
  
  

Remote Work Requirements

• High speed cable or fiber internet
• Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at )
• Please review for additional information

Salary Range

• $120-$140k
• The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills and experience.

Remote Worker Requirements

• We are a remote-first organization and offer remote work in the following approved states:
  Arizona, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Jersey, North Carolina, North Dakota, Ohio, South Carolina, South Dakota, Texas, Virginia, Wisconsin

Benefits

• Remote work
• Performance bonus and/or merit increase opportunities
• 401(k) with dollar-per-dollar match up to 6% of salary (100% vested immediately)
• Competitive paid time off
• Health insurance, dental insurance, and telehealth services start DAY 1
• Employee Resource Groups
• Professional and Leadership Development Programs
• Review additional benefits: ()

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