Supervisor - Clinical Operations, Nurse

Government Employees Health Association, Inc. (G.E.H.A) is a nonprofit member association that provides health and dental benefits that millions of federal employees and retirees, military retirees and their families have counted on since 1937. Offering one of the largest health and dental benefit provider networks available to federal employees in the United States, G.E.H.A empowers health and wellness by meeting its members where they are, when they need care. G.E.H.A has one mission: To empower federal workers to be healthy and well. The Supervisor leads and has oversight of day-to-day operations with full accountability for team performance, outcomes, and regulatory compliance. Responsible for supervising daily operations, serving as the primary contact for clinical (licensed) and non-clinical (non-licensed) staff. Directly supports clinical teams through clinical and operational decision-making, evidence-based practice, and medical expertise. Partners with leadership to develop, implement, and maintain policies, procedures, and workflows to ensure regulatory and organizational compliance. SKILLS Duties and Responsibilities: Owns and oversees day-to-day process across the organization for their specific workstream, and ensures staff compliance with program workflows, clinical documentation, benefit resource allocation, and work distribution. Responsible for oversight of complex or escalated case investigations and notifies department leadership as appropriate. Coordinates department workload and identifies staffing needs or other resources to meet quality, quantity, and departmental goals. Communicates changes in departmental processes and procedures to staff when necessary. Serves as primary contact for staff, assigned internal and external programs and escalated issues. Identifies potential process improvement opportunities across departments and makes recommendations to leadership as appropriate. Audits staff processes and reviews cases with staff to assess compliance with established clinical and clinical support guidelines, workflows, and adherence to benefits structure and applicable regulations. Consults with the leadership regarding complex and/or high-profile cases. Recommends promotion, termination, hiring or reassignment of subordinates including scheduling and conducting informal and formal employee performance reviews, coaching and competency assessments. Leads performance management, coaching, and talent development to build a high‑performing, engaged team. Reviews performance issues with leadership and makes recommendations regarding level of discipline including developing performance improvement plans and delivering disciplinary action after reviewing with leadership and Human Resources. Develops, implements, and maintains internal policies and procedures. Coordinates department project planning to accommodate the company's annual business needs. Works with management team to develop future programs and goals. Collaborates with clinical staff and Medical Director regarding medical cases to ensure services are clinically appropriate. Assists with development of department training materials. Identifies educational opportunities for the staff. Collaborates with Clinical Operations Division educator to provide educational opportunities. Uses performance metrics and data analysis to identify trends, drive continuous improvement, and improve outcomes. Knowledge, Skills, and Abilities: Requires a bachelor’s degree in clinical field for which the team has responsibility. (Example: Nursing teams would need a BSN) Associates degree in a related health field may be considered with 5 years of experience Active/Good standing RN license, including accountability for maintaining all requirements of licensing post hire, must be eligible to be licensed in all US states and territories. 1-3 years leadership experience Demonstrates excellent verbal and written communications skills. Shows strong collaboration skills and the ability to build productive working relationships. Displays a high level of self-initiative and independent problem-solving skills. Preferred: Nursing experience in Fertility, Obstetrics, Labor, and Postpartum care. Case Management experience is preferred Work-at-home requirements Must have the ability to provide a non-cellular High Speed Internet Service such as Fiber, DSL, or cable Modems for a home office. A minimum standard speed for optimal performance of 30x5 (30mpbs download x 5mpbs upload) is required. Latency (ping) response time lower than 80 ms Hotspots, satellite and wireless internet service is NOT allowed for this role. A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information How we value you Competitive pay/salary ranges Incentive plan Health/Vision/Dental benefits effective day one 401(k) retirement plan: company match – dollar for dollar up to 4% employee contribution (pretax or Roth options) plus a 6% annual company contribution Robust employee well-being program Paid Time Off Personal Community Enrichment Time Company-provided Basic Life and AD&D Company-provided Short-Term & Long-Term Disability Tuition Assistance Program While this is a remote opportunity, at this time G.E.H.A does not hire employees from U.S. territories or the following states: Alaska, Hawaii, California, Washington, Oregon, Colorado, Wyoming, Montana, New York, Connecticut, Vermont, Pennsylvania, Maine. Please note that the salary information is a general guideline only. G.E.H.A considers factors such as (but not limited to) scope and responsibilities of the position, candidate’s work experience, education/training, key skills, internal peer equity, as well as, market and business considerations when extending an offer. The target hiring range for this position is $92,682 - $117,249 USD. At G.E.H.A, the current maximum salary for this role is $130,649 USD. While initial compensation may vary based on experience and qualifications, there is a path to work toward this top rate through performance and continued growth within the organization. G.E.H.A is an Equal Opportunity Employer, which means we will not discriminate against any individual based on sex, race, color, national origin, disability, religion, age, military status, genetic information, veteran status, pregnancy, marital status, gender identity, and sexual orientation, as well as all other characteristics and qualities protected by federal, state, or local law. G.E.H.A will not discriminate against employees or applicants because they have inquired about, discussed, or disclosed their compensation or the compensation of another employee or applicant. We are committed to creating an inclusive environment for all employees. G.E.H.A is headquartered in Lee's Summit, Missouri, in the Kansas City area. We recognize the importance of balance and flexibility and offer hybrid and work-from-home options for many of our roles. Please note: Due to recent fraudulent activity in the job market, if you receive correspondence from someone at G.E.H.A, we recommend you review the following facts to help verify if someone is truly a G.E.H.A employee before sharing any personal information. All email addresses of G.E.H.A employees will end with our domain, @geha.com. Any other domain is not verified and is illegitimate. Please double check the spelling as well. We will never extend a job offer without having at least one live video call. We will never ask you for or provide you with any money, personal or banking information during the interview process or before signing an offer letter. Please report any suspicious messages to View email address on click.appcast.io so that we can help reduce this fraudulent activity. Government Employees Health Association, Inc. (G.E.H.A) is a nonprofit member association that provides health and dental benefits that millions of federal employees and retirees, military retirees and their families have counted on since 1937. Offering one of the largest health and dental benefit provider networks available to federal employees in the United States, G.E.H.A empowers health and wellness by meeting its members where they are, when they need care. G.E.H.A has one mission: To empower federal workers to be healthy and well. Your FUTURE is here with us –COME GROW WITH G.E.H.A! Benefits start on day one! Great 401(k) match! Tuition assistance programs! Professional development! Advancement opportunities! For additional information, please visit GEHA Careers.