Clinical, Supervisor - RN - Full-time (Remote U.S.)

Acentra Health, LLC

86d • $67,270 - $87,360

About The Position

Acentra Health is looking for a Clinical Supervisor - RN - Full-time (Remote U.S.) to join our growing team. As the Clinical Supervisor – RN – Full-time (Remote U.S.), this individual plays a pivotal role in overseeing and managing Utilization Management (UM) and/or Level of Care (LOC) determination activities within the organization. With a strong clinical foundation and leadership acumen, the Clinical Supervisor ensures that UM processes are executed efficiently, consistently, and in alignment with regulatory and contractual standards. A key focus of the role is to uphold excellence in clinical programs, fostering continuous improvement and innovation in care management practices. Additionally, the Clinical Supervisor is instrumental in cultivating and maintaining strong relationships with customers and stakeholders, ensuring that service delivery meets or exceeds expectations and contractual obligations. The Clinical Supervisor will also have oversight of direct reports.

Requirements

• Active, unrestricted Registered Nurse (RN) license in the state of South Carolina or a valid compact state license.
• 5+ years of experience as a practicing RN.
• 3+ years of supervisory experience in a healthcare setting.
• 2+ years in Utilization Management (UM).
• 2+ years of experience applying clinical criteria in utilization review processes (e.g., InterQual and/or MCG).
• 1+ years of experience working with Members with Intellectual and Related Disabilities, Autism Spectrum Disorder, Traumatic Brain Injury (TBI) or Spinal Cord injury, or 1+ years of Case Manager experience.

Nice To Haves

• Bachelor's degree.
• Strong verbal and written communication skills, with the ability to convey complex information clearly and professionally.
• Demonstrated customer-centric approach with a focus on achieving results and fostering positive relationships with internal and external stakeholders.
• Excellent organizational and time management skills, with the ability to prioritize multiple tasks effectively.
• Proven ability to work both independently and collaboratively within a team environment.
• Proficiency in Microsoft Office Suite and other relevant software applications essential to the role.
• Ability to provide technical guidance and leadership support to management and clinical teams.

Responsibilities

• Lead and oversee all Utilization Management (UM) and/or Level of Care (LOC) determination activities including prior authorizations, exception requests, and service plan reviews ensuring accuracy, consistency, and timely completion.
• Conduct utilization reviews as needed to support workload demands and program requirements.
• Monitor daily work queues and adjust staffing schedules to align with departmental demands.
• Evaluate productivity and performance metrics of nurse reviewers to maintain high standards of efficiency and quality.
• Identify onboarding and ongoing learning needs for Clinical Reviewers; collaborate with leadership to design and implement effective development plans.
• Actively participate in leadership meetings, committees, and cross-functional workgroups to promote shared decision-making and continuous improvement.
• Oversee quality assurance activities such as audits, Quality Improvement Plans (QIPs), database management, and Inter-Rater Reliability (IRR) support.
• Identify areas for process and clinical improvements; develop and execute action plans to enhance outcomes.
• Serve as a liaison to customers and providers, ensuring timely resolution of issues and promoting service excellence.
• Stay current with clinical best practices, UM protocols, and Medicaid policy and act as the primary resource for nurse reviewers.
• Support departmental and organizational goals by performing additional duties as assigned.

Benefits

• Comprehensive health plans
• Paid time off
• Retirement savings
• Corporate wellness
• Educational assistance
• Corporate discounts

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Bachelor's degree