Supervisor, Clinical Review Alabama

COMAGINE HEALTH

8h

About The Position

This role requires that the employee is an active RN and based in Alabama.

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.

Requirements

• All nurse reviewers will be located and licensed within Alabama and in good standing with the Alabama Board of Nursing and Board of Medical Examiners.
• Experience with: Performing PA reviews
• Long-term care including nursing home, ICF/IID, swing bed, PEC, and inpatient psychiatric facilities
• Minimum of 3 years of clinical experience in a healthcare setting.
• At least 1 year of supervisory or team leadership experience in a clinical environment.
• 1 year of medical management / utilization review experience
• Strong knowledge of clinical review processes, healthcare regulations, and medical terminology.
• Proficiency with electronic medical records (EMR) systems and clinical documentation standards.

Nice To Haves

• LCSW, LPC licensure or equivalent clinical certification.
• 3 years of medical management / utilization review experience
• Experience with health plan operations or managed care organizations.
• Familiarity with state and federal healthcare regulations, including HIPAA and CMS guidelines.
• 5 years of clinical (direct patient care) experience

Responsibilities

• The supervisor, will display, critical thinking abilities, strong leadership skills, wise decision-making abilities, organized, knowledgeable and excellent communicator.
• 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

Benefits

• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: No Education Listed