Job Description

Job Summary:

The Manager, Clinical Call Center Operations is responsible for coordinating and leading inbound and outbound call center activities to achieve compliance with AAACN, URAC, NCQA, and regulatory standards.

Essential Functions:

• Guide team leaders on effective people management strategies such as staffing, coaching and mentoring to maintain a high level of department morale, operational efficiency and delivering an exemplary customer experience
• Collaborate with work force management team to provide optimal staffing and ongoing monitoring of the staffing model
• Assist in the development of department policies, procedures and call management processes
• Collaborate with other organizational departments on integration of cross departmental processes to achieve optimal efficiencies
• Prepare and present data and regulatory compliance reports to stakeholders and leadership team
• Monitor and approve regulatory reports
• Assist senior leadership with member and staff related concerns
• Promote operational excellence through process monitoring, improvement, and change management
• Identify departmental opportunities and develop effective solutions to enhance efficiency, effectiveness, and service delivery
• Coordinate department specific orientation and continuing education
• Collaborate with Workforce Management Team in monitoring service levels and analyze for trends
• Oversee departmental Clinical Quality Team Clinical Quality Improvement activities
• Act as a resource to employees and provide clinical, technical and procedural guidance
• Provide support for staff and leadership to ensure 24/7 coverage of operations, including on-call responsibilities, business continuity activation, timely responses to state generated inquiries, and staffing situations 
• Monitor and analyze call data and provide input to leadership to improve service quality and operational efficiency
• Ensure compliance with healthcare regulations and compliance standards relevant to various markets and the nurse advice lines metrics
• Perform any other job duties as requested

Education and Experience:

• Registered Nurse is required
• Bachelor’s degree or equivalent years of work experience is required, BSN is preferred
• Minimum of five (5) years of clinical experience is required
• Minimum of three (3) years progressive’ management experience is required
• Call center or Telephone Triage experience is required
• Managed care experience is highly preferred

Competencies, Knowledge and Skills:

• Superior Nursing Process Skills
• Strong understanding of nursing practices, medical terminology, and crisis management.
• Strong clinical leadership experience/skills
• Data analysis and trending
• Critical listening and thinking skills
• Training and teaching skills
• Time management skills
• Strong Word, Excel, and PowerPoint experience required; intermediate level experience preferred
• Exceptional written and verbal communication skills
• Strong critical thinking, decision making and problem solving skills
• Strong Customer service orientation
• Ability to develop, prioritize and accomplish goals
• Strong organizational skills to manage multiple tasks, schedules, and priorities effectively.
• Ability to adapt to changing circumstances, including evolving healthcare practices and regulations.

Licensure and Certification:

• Current, unrestricted Registered Nurse (RN) license in state or practice is required
• Ability to obtain licenses in multiple states in which CareSource serves members

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• May be required to work non-traditional hours to fulfill essential functions of the position because the department operates 24/7/365

Compensation Range:
$81,400.00 - $130,200.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type:
Salary

Competencies:
- Create an Inclusive Environment - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.

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