Utilization Management, Clinical QA Supervisor

Dane Street•West Palm Beach, FL

1d•Remote

About The Position

The Clinical QA Supervisor is responsible for the oversight of the review of Physician reports and accompanying medical records to ensure that the report is complete, accurate, and consistent with medical evidence. This role involves supervising QA staff, managing the File Review Board for timely and accurate file processing, providing details of board reviews to managers, and assisting in identifying and correcting staff performance issues. The supervisor will also help in hiring qualified candidates, ensure staff adhere to job duties such as following up with physicians for outstanding reports, reviewing received reports for accuracy, delivering completed reports, and following client-specific instructions. Additionally, the role requires active participation in issue resolution, ensuring referrals meet client-directed Turn Around Time (TAT), and acting as a liaison between reviewers, team members, and clients regarding file status. Other duties and special projects may be assigned based on business needs.

Requirements

RN licensure required
Medical peer review or healthcare industry knowledge required.
Present exceptional communication skills with a clear understanding of company business lines.
The ability to apply critical thinking, manage time efficiently and meet specific deadlines.
Computer literacy and typing skills are essential.

Nice To Haves

An Associate’s Degree or Bachelor’s Degree is preferred.
Business experience in a healthcare and/or insurance setting is preferred.

Responsibilities

Oversight of the review of Physician reports and accompanying medical records to ensure completeness, accuracy, and consistency with medical evidence.
Ensure appropriate QA staff are assigned to each file to designate file handling responsibilities amongst the team.
Supervise the assigned staff and manage the File Review Board to ensure a timely and accurate process of each file.
Provide details of board reviews to managers to ensure efficiency and productivity of staff.
Assist in identifying & correcting staff performance including promotions, discipline, coaching and termination of staff.
Assist in hiring qualified candidates for QA open positions.
Ensure that all QA staff adhere to and meet their specific job duties including but not limited to: Following up with Physicians for outstanding reports, Reviewing received reports for accuracy, Delivering completed reports back to all applicable parties, Following all client-specific instructions.
Actively participate in issue resolution by working with the required QA, physicians, account managers, and/or other related parties.
Ensure referrals meet the client-directed Turn Around Time (TAT).
Act as the liaison between the reviewer, team member and client regarding the process or status of the file.
Other duties & special projects, as assigned and based on business needs.