Associate Manager US Clinical Operations RN

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.

The role of an RN Assistant Manager Operations is to assist in managing overall account performance and financial profits by coaching and developing Supervisors to deliver quality performance. Managing Supervisors to ensure day to day operations are successful.

Job title:

Associate Manager US Clinical Operations RN

Job Description:

Education:

Associate degree or diploma in nursing.  Bachelor’s degree in nursing preferred 

Experience:

3 years experience in a clinical call center environment or telehealth environment preferred.
2 years of leadership experience
Healthcare preferred

Mandatory Skills:

• Active, unrestricted nursing license (for nurses)

• Strong management, interviewing, hiring, coaching, and counseling skills

• Ability to manage multiple projects to successful and timely completion

• Excellent communication skills; written, verbal

• Strong presentation skills

• Demonstrated sound problem-solving analytical and decision-making skills

• Knowledge of quality improvement processes

• Possesses leadership qualities of courage, integrity, the ability to motivate others and the ability to promote harmony in the workplace

• Works effectively leading a team and participating on a team

• Strong member advocate: willing to go above and beyond normal responsibilities to provide the best service possible

• Ability to assist member in navigating the healthcare system and community-based resources.

• Culturally sensitive and competent regarding membership served

• Ability to work remotely

• Ability to determine when to escalate issues appropriately and in a timely manner.

• Proficient computer skills.

• Thorough knowledge of case management.

• Knowledge of/experience in disease management.

• Understanding of family and group dynamics.

• Familiarity with change behavior techniques.

• Demonstrates empathy

• Must have experience managing teams in a virtual environment

Preferred Skills:

Basic financial acumen (cost-effectiveness, cost-benefit etc.)

Roles & Responsibilities:

Shift Management Function:

• Accountable for the shift operations.

• Ensures execution of contingency and disaster recovery plans.

• Ensures Contact Center meets productivity standards and client service levels are met or exceeded.

• Reviews and analyses productivity reports prepared by the team leaders before the reports are submitted to the Operations Manager.

• Submits periodic productivity/service performance reports to the Operations Manager.

• Prepares the schedule /Team Leaders assignments to ensure that all operational hours are supervised.

• Regularly conducts dialogues, communication sessions with agents/front liners (skip meetings).

• Ensures that workplace is safe, conducive, and a healthy working environment.

• Implements operational management policies in order to ensure adherence to service level agreements between clients.

• Coordinates with workforce with regards to approval/disapproval of request for unscheduled leaves and tardiness and the necessary adjustments to schedules of available manpower in order to meet requirements.

• Ensures preparation of client required reports and makes necessary endorsements to ensure that deadlines for submission of reports are met.

• Be able to analyze and recommend measures in order to meet set metrics based on trends.

• Ensures all team monitor service calls to observe employee’s demeanor, technical accuracy, and conformity to company policies.

• Be able to ensure that operations run smoothly on a daily basis.

• Be able to coordinate with Workforce to ensure Service Levels and program goals are met.

• Recommends corrective services within client limits to adjust customer complaints.

• Answers questions about service to Team Leaders and works to develop so repeat questions do not arise.

• Strives to help the entire team when in need of assistance.

• *Communicates policy changes, program developments, and company news to their respective teams, supporting the business decisions while supporting the staff in any required adjustments

Clinical Management Function:

• Takes escalated calls to resolve provider and member concerns that cannot be handled by supervisors and front-line staff.

• Follows through with pending client escalations’ requests (example: pre-authorization requests) requiring supervisor’s assistance; reviewing outcome of case rework prior to handing it over to the clients.

Quality Management/Standards Compliance Function:

• Conducts performance reviews and appraisals for Team Leaders (monthly/midyear/yearly).

• Reviews preliminary investigation of disciplinary cases and approves/disapproves/escalates disciplinary actions in adherence to the provisions of the Company Code of Conduct.

• Conducts regular inter and intradepartmental operations, feedback, action planning, meetings for dissemination of policies and products, hardware issues, troubleshooting, review of status reports, etc.

• Participates in the development of contingency plans, escalation procedures, and disaster recovery plans.

• Regularly reviews staffing requirements, actual headcount vs. budget, and requisitions for manpower when necessary.

• Ensures implementation of customer complaint escalation and turnaround time for complaint resolution to meet service level agreements.

• Participates in the preparation of the department’s annual business plan and budget to support Sagility’s objectives and goals.

• Ensures operation’s compliance with the client’s requirements and policies.

• Provides recommendations in the setting of call center systems pameters.

• Be able to implement action plans to ensure alignment between the other support groups.

• Be able to communicate as needed with other departments within the Contact Center about operational and personnel needs.

• Be able to analyze situation arises outside the established guidelines or parameters and be able to evaluate such situation for impact on present.

• Be able to give recommendations and implement these recommendations once approved to ensure process improvement in order to help the program achieve its goals.

• Studies and standardizes procedures to improve efficiency of subordinates. Informs all parties when system is not working effectively.

• Works with call center Director to develop better ways for system to improve quality.

• Be able to be responsible in the performance of his/her team.

• Responsible for the development and implementation of policies and procedures pertaining to HIPAA and ensures the center follows Privacy Rules Standard

Staff Development Function:

• Be able to provide bi-monthly one-on-one coaching and feedback to drive performance and reduce cost.

• Be able to provide immediate coaching regarding TL or team performance when the need arises using documented personal observations or critical incidences to improve TL and team performance.

• Be able to ensure timely and accurate communication regarding updates to team leaders.

• Be able to initiate and support all employee satisfaction and workplace programs.

• Disciplines and creates incentives for all staff in conjunction with meeting performance measurements.

• Be able to answer questions about service to the Team Leaders.

• Be able to recommend and apply corrective measures for staff members who do not meet minimum performance metrics.

• Be able to monitor key performance indicators within and across teams to assure that standards are met across the board.

• Be able to work with Team Leaders to resolve concerns of agents as well as their own.

• Be able to follow-up personnel issues (e.g. Payroll, HR, etc.) as reported by TLs.

• Be able to meet with TLs at least once a week to discuss program and team performance and share best practices.

• Be able to ensure TLs submit accurate and timely reports (ex. Coaching logs, performance review, etc.).

• Be able to create specific Individual Development Plans for TLs over a given period of time to prepare them to the next level.

Administrative Function:

• Be able to file accurate and timely agent coaching logs from TLs.

• Be able to file the weekly / monthly team performance reviews.

• Be able to implement programs to ensure high levels of Quality.

• Be able to develop initiatives to optimize results.

• Be able to partner with other Shift Managers to share / implement best practices.

• Be able to monitor team performance in Chronicle on a daily basis.

• Submit weekly and monthly team operations review to Operations Manager.

Others:

• Perform tasks assigned by the Operations Manager.

• Prepare composite reports from the individual reports of subordinates.

• Communicate as needed with other departments within the Contact Center about operational and personnel issues.

• Interviews and staff supervisor team.

• Handle the overall project, Budgeting & Financials, Strategies to improve teams KPIs, SPOC for the client relations, profitability of the project, Planning & Process improvements.

General Safety and Security:

• Protects the organization’s assets by upholding the principles of the Quality Information Security Management System (QISMS)

• Ensures confidentiality, integrity, and availability of information critical to fulfilling the organization’s business functions

• Remain compliant with the relevant business, local and international regulatory and legislative requirements particularly the Health Insurance Portability and Accountability Act of 1996 (HIPAA), HITECH Act and URAC

The above statements are intended to indicate the general nature and level of work being performed by employees within this classification. They are not intended to be an exhaustive list of all responsibilities, duties and skills required of employees assigned to this job.  Employees in this job may perform other duties as assigned.

Location:

Work@Home USAUnited States of America