Supervisor, Clinical Review

Supervisor, Clinical Review

Comagine Health is a national, mission-driven, nonprofit organization that has engaged in health care quality consulting and quality improvement services for more than 50 years. We are leaders in assisting front-line providers and engaging health care partners to improve care delivery and patient outcomes. Our talented remote workforce spans the country and plays a vital role in our success. We go beyond merely providing a remote work option; we support and embrace it. We offer opportunities to make a difference from anywhere in the U.S. and enjoy better work-life balance. An annual stipend gives you the freedom to enhance your workspace with options that suit your needs. We believe in an environment that allows you to thrive both personally and professionally. That's why we offer benefits that include : medical, dental and vision insurance, paid time off for vacation, illness and volunteering, retirement savings plan with employer contribution, adoption financial assistance, paid parental leave and much more!

Comagine Health actively cultivates an organizational culture that fosters well-being and prioritizes engagement, connectedness and collaboration among team members. Each employee's unique background, perspective and abilities are fundamental to the success of our mission and organization. Comagine Health is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability. We are proud to be a Recovery Friendly Workplace, supporting the health and well-being of all employees.

About the Role

This role requires that the employee is an active RN. The Supervisor, Clinical Review plays a critical role in providing operational supervision of clinical staff who conduct utilization review and / or specialty reviews. The Clinical Review supervisor will guide and monitor, and train clinical reviewers to identify medical necessity / medical appropriateness as identified by identified criteria, specific contract guidelines, and / or organizational clinical criteria.

Minimum Qualifications

• Minimum of 3 years of clinical experience in a healthcare setting.
• Active RN licensure.
• At least 1 year of supervisory or team leadership experience in a clinical environment.
• 1 year of medical management / utilization review experience
• 3 years of customer service or other relevant work experience
• Strong knowledge of clinical review processes, healthcare regulations, and medical terminology.
• Proficiency with electronic medical records (EMR) systems and clinical documentation standards.

Preferred Qualifications

Responsibilities

The supervisor, will display critical thinking abilities, strong leadership skills, wise decision-making abilities, organized, knowledgeable and excellent communicator. InterQual criteria experience preferred Demonstrated leadership ability within a team, including management of personnel, meeting targets, and facilitating process improvement efforts. Competent in understanding medical / clinical terminology, diagnoses, and documentation.