Supervisor of Clinical Review

Acentra Health, LLC•UNAVAILABLE, UNAVAILABLE

12d•Remote

About The Position

Acentra Health is looking for a Supervisor of Clinical Review to join our growing team. As Supervisor of Clinical Review, this individual plays a pivotal role in overseeing and managing the Utilization Management (UM) 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. This position is remote U.S.

Requirements

Active, unrestricted RN or LPN/LVN license.
A minimum of 2+ years of experience as a practicing RN or LPN/LVN.
A minimum of 1 year of experience leading, coaching, and developing staff in a healthcare environment, including at least 1 year in Utilization Management.
A minimum of 1+ 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.

Nice To Haves

Associate degree or equivalent experience directly applicable to clinical practice.
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 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.