Clinical, Supervisor

Acentra Health, LLC

12h•Remote

About The Position

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise, with a mission to innovate health solutions that deliver maximum value and impact. The company encourages employees to 'Lead the Way' by embracing its mission, actively engaging in problem-solving, and taking ownership of their work, offering unparalleled opportunities for career acceleration. The Clinical Supervisor – RN – Full-time plays a pivotal role in overseeing and managing the Utilization Management (UM) activities within the organization. With a strong clinical foundation and leadership acumen, this individual 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. The Clinical Supervisor and direct reports are expected to work Monday through Friday, with participation in a rotating schedule that includes weekends and holidays. This position is remote U.S. with working hours between 8:00 a.m. and 6:00 p.m. EST, including rotational evenings, weekends, and holidays as required.

Requirements

Active, unrestricted Registered Nurse (RN) license in the state of Indiana or a valid compact state license.
Associate degree or equivalent experience directly applicable to clinical practice.
A minimum of 5+ years of experience as a practicing RN.
A minimum of 5+ years of supervisory experience in a healthcare setting with a minimum of 2+ years in Utilization Management.
A minimum of 2+ years of experience applying InterQual and/or MCG clinical criteria in utilization review processes.
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.
Working hours between 8:00 a.m. and 6:00 p.m. EST, with rotational evenings, weekends, and holidays as required.

Nice To Haves

Bachelor's degree.
Ability to provide technical guidance and leadership support to management and clinical teams.

Responsibilities

Lead and oversee all Utilization Management (UM) activities including prior authorization and retrospective 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 and UM protocols, act as the primary resource for nurse reviewers regarding clinical review inquiries.
Support departmental and organizational goals by performing additional duties as assigned.
Read, understand, and adhere to all corporate policies, including policies related to HIPAA and its Privacy and Security Rules.