Supervisor of Clinical Review

Acentra Health, LLC•UNAVAILABLE, UNAVAILABLE

5d•Onsite

About The Position

Acentra Health is looking for a Supervisor of Clinical Review to join our growing team. This role supervises the day-to-day activities of nurse reviewers or prior authorization requests in assigned areas to successfully meet contract deliverables. The position also assists in meeting contract deliverables related to the Review Department within budgetary parameters.

Requirements

Active RN or LPN licensure required (Preferred RN)
Vocational Degree, ASN or equivalent nursing education required; BSN or related bachelor's degree preferred.
Minimum of three (3) years supervisory experience in a healthcare field with a minimum of 1-3 years' review experience required.
Previous workload management experience strongly preferred.

Nice To Haves

Excellent verbal and written communication skills essential.
Excellent interpersonal skills required.
Organizational skills, ability to plan and prioritize multiple assignments essential.
RN/BSN
Computer proficiency in Microsoft Office and other software programs operating in a Windows environment.

Responsibilities

Assures accuracy and timeliness of all applicable review type cases within contract requirements.
Assesses, evaluates and addresses daily workload and queues; adjusts work schedules daily to meet the workload demands of the department.
Analyzes productivity of nurse reviewers.
Identify Clinical Reviewers' orientation and continuous learning needs and in collaboration with the Manager, Operations, develops and implements plans to address those identified learning needs.
Responsible for the quality monitoring activities including identifying areas of improvement and plan implementation of improvement areas including quarterly audits, QIP, database management, and assisting with IRR.
Maintains current knowledge base related to review processes and clinical practices related to the review processes; functions as the initial resource to nurse reviewers regarding all review process questions and/or concerns.
Functions as providers' liaison and contact/resource person for provider customer service issues and problem resolution.
Performs all applicable review types as workload indicates.
Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.