Clinical Supervisor-Critical Incidents (Full Time Remote, North Carolina Based)

Under leadership of the Director of Incidents, Grievances, and Appeals, the Supervisor of Clinical Incidents, Grievances, and Appeals will supervise and manage the incident reporting function and provide clinical guidance member appeals and grievance functions.

This position is full-time remote opportunity. The selected candidate must reside in North Carolina.

 Responsibilities & Duties

Supervision of Incident Reporting Team

• Provide daily administrative and clinical supervision to incident reporting staff
• Ensure that timelines for processing and escalating incident reports are in compliance with state requirements
• Provide training and technical support to providers related to incident reporting compliance
• Work closely with legal and compliance departments to ensure that incident reporting policies are compliant with all relevant regulations and contractual requirements
• Participate in state calls related to incident reporting to remain current with NC-IRIS: the state incident reporting electronic system
• Provide data related to level III incidents and incidents posing potential risk to plan leadership in a timely manner and ensure timely responses to incidents
• Compile and analyze data related to incident reporting trends and patterns to share with internal and external audiences

Clinical Quality Review Committee (CQR)

• Maintain and update the workflow and desk procedures for the CQR committee
• Collaborate with the grievance and incident teams to determine cases to be presented to the committee 
• Serve as chair of the CQR Committee. Collaborate with the Medical Team to review cases and make follow up recommendations as needed
• Lead incident reporting staff in collaborating with providers to complete follow up recommendations 

Clinical Consultation and Support

• Develop and implement a process for referring grievance and appeals cases for clinical consultation
• Participate in clinical staffing of grievances and appeals as necessary
• Coordinate responses to concerns submitted to the plan via SNOW tickets
• Represent the Incident, Grievance and Appeals teams on various internal committees including those addressing high clinical risks to members’ health and safety

Manage and Develop Staff

• Work with Human Resources and the director of Incidents, Grievances, and Appeals to attract, maintain, and retain a highly qualified and well-trained workforce
• Ensure staff are well trained in and comply with all organization and department policies, procedures, and business processes
• Organize workflows and ensure staff understand their roles and responsibilities
• Ensure the department has the needed tools and resources to achieve organizational goals and to support employees and ensure compliance with licensure, regulatory, and accreditation requirements
• Actively establish and promote a positive, diverse, and inclusive working environment that builds trust 
• Ensure all staff are treated with respect and dignity
• Ensure standards are transparent and applied consistently, impartially, and ethically over time and across all staff members
• Work to resolve conflicts and disputes, ensuring that all participants are given a voice
• Set goals for performance and deadlines in line with organization goals and vision
• Effectively communicate feedback and provide ongoing coaching and mentoring to staff and support a learning environment to advance team skills and professional development
• Cultivate and encourage efforts to expand cross-team collaboration and partnership

Minimum Requirements

Education & Experience

Required:

Master’s degree in health and human Services field from an accredited college/university with five (5) years in Behavioral Health service provision and/or management with two (2) years’ experience in Incident Reporting or Quality Management 

Provisional or full licensure as LCSW, LCMHC, LPA, or LMFT required.

Preferred: 

Prior experience with incident reporting via NC-IRIS and supervisory experience

Knowledge, Skills, & Abilities

• Self-motivated, able to take initiative, and work independently with minimal oversight to meet timelines, strong follow-through skills and a solutions-oriented attitude.
• Ability to analyze essential facts, make timely and sound decisions, make recommendations, and resolve performance and job-related issues.
• Excellent written and verbal communication skills
• Advanced knowledge in the use of web-based technology and Microsoft Office applications such as Word, Excel, and Power Point. Proficient with database entry
• Working knowledge of medical insurance and managed care principles and knowledgeable of CPT and ICD-10 coding systems
• Knowledge of NCQA requirements of utilization review, appeal rights and responsibilities, and regulatory requirements at the state and federal level for health care administration and Carrier standards

Salary Range

$75,600 - $100,107/Annually

Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity. 

An excellent fringe benefit package accompanies the salary, which includes:  

• Medical, Dental, Vision, Life, Long Term Disability
• Generous retirement savings plan
• Flexible work schedules including hybrid/remote options
• Paid time off including vacation, sick leave, holiday, management leave
• Dress flexibility