Clinical Review Supervisor
Our client is seeking a Clinical Review Supervisor to lead a team of clinical professionals delivering high-quality utilization management services. This leadership role focuses on team development, operational oversight, compliance adherence, and process improvement within a fast-paced healthcare environment. The ideal candidate brings a blend of clinical expertise, regulatory knowledge, and team supervision experience.
This role is fully remote to candidates located in Alaska or any state located within the Pacific or Mountain Time Zones.
Clinical Review Supervisor Responsibilities
- Oversee recruitment, onboarding, training, performance evaluations, and staff development in coordination with HR and leadership teams.
- Ensure proper resources, tools, and subject matter expertise are available for the clinical team to operate effectively.
- Provide timely performance feedback and initiate corrective action plans aligned with organizational standards.
- Develop and manage professional development plans and performance expectations for clinical team members.
- Coordinate team workflow to ensure timely and accurate deliverables and adherence to review criteria.
- Support utilization management activities, including conducting audits, complex case reviews, and peer referrals.
- Deliver individualized and group training based on performance metrics and quality standards.
- Lead or assist in policy and procedure development to ensure compliance with contractual, legal, and accreditation requirements.
- Serve as a liaison to internal stakeholders such as behavioral health, medical affairs, and quality management.
- Contribute to internal reporting and participate in interview and hiring processes as needed.
- Ensure timely escalation of operational issues, staff concerns, and performance metrics to leadership.
- Promote customer service excellence and foster a culture of accountability and clinical integrity.
Clinical Review Supervisor Qualifications
- Active, unrestricted RN license is required.
- Case Management Certification (CCM) is required if performing case management duties, or must be obtained within two years of hire.
- Minimum of 3 years’ experience in medical management and customer service or a related field.
- At least 1 year of supervisory or team lead experience preferred.
- 5 years of direct patient care experience is desirable.
Preferred Knowledge and Competencies:
- Demonstrated critical thinking and decision-making skills.
- Strong leadership capabilities with the ability to guide, mentor, and evaluate staff.
- Effective verbal and written communication skills.
- Familiarity with Medicaid processes and quality control standards.
- Experience using InterQual criteria is a plus.
Salary: $81K-$113K/year. (DOE & Location)
Benefits
Benefits are available to eligible full-time employees and include coverage for medical, dental, vision, life insurance, short and long term disability, and matching 401k.
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