Clinical Manager

WPS, a health solutions company, is a leading not-for-profit health insurer and federal government contractor headquartered in Madison, 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 has been making healthcare easier for the people we serve for nearly 80 years. Proud to be military and veteran ready.

Our Clinical Manager is accountable to plan, organize, manage, and evaluate clinical operations for Medical Review. This includes developing Centers for Medicare & Medicaid Services (CMS) reports as well as managing activities to ensure accurate rendering of claim decisions. They collaborate with other business areas to ensure WPS and CMS goals and objectives are met utilizing cost-effective, timely, accurate, and innovative methods. This Clinical Manager is accountable to ensure compliance with regulatory and payor guidelines. Salary Range $100,000 ~ $120,000 The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, and experience. Work Location: Remote OR Hybrid We are open to remote work in the following approved states: Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, Ohio, South Carolina, Texas, Virginia, Wisconsin **Employees living within 45 miles of WPS Headquarters (1717 W. Broadway in Madison, WI) will be expected to be able to come into the office 2 days a week on a regular basis.

Can develop, implement, and maintain the Improper Payment Reduction Strategy (IPRS) for Medical Review. Enjoy leading people monitoring and maintaining Full Time Equivalents (FTEs), budget, and workload according to IPRS. Thrive when ensuring accurate and timely handling of Medical Review clinical decisions. Can monitor all results for Medical Review Accuracy Award Fee, providing follow-up, dispute, and education as indicated. Have coordinate with the Medical Review Operations Manager in preparation of the Monthly Status Report. Want to ensure effective and timely response to clinical concerns raised by CMS, other CMS contractors and other clinical areas. Can maintain detailed knowledge of all Medicare regulations and broad level knowledge of WPS business capabilities. Have ensured compliance within federal and state regulations, CMS guidelines, and company policies. Enjoy coaching and mentoring the Clinical Med Management team to ensure a culture of accountability and excellence; execute programs to drive employee engagement and satisfaction.