Role Description
The Clinical Review Supervisor provides operational supervision of clinical staff conducting utilization review and specialty review activities. This role is responsible for guiding, training, and supporting clinical reviewers to ensure accurate determinations regarding medical necessity, quality, and appropriateness of healthcare services. The supervisor also supports operational excellence through quality oversight, staff development, regulatory compliance, and collaboration with internal and external stakeholders. While this is a fully remote position within the United States, the work hours are going to be based on the Pacific Standard Time zone.
Key Responsibilities
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Conduct prospective, concurrent, retrospective, and pre-authorization utilization reviews using InterQual, an evidence-based clinical criteria tool, organizational policies, and regulatory guidelines.
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Supervise utilization management, care coordination, and/or case management activities to ensure quality, compliance, timeliness, and contractual performance standards are met.
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Serve as an escalation point for complex clinical or operational concerns and communicate significant issues to leadership appropriately.
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Support quality management initiatives, audits, training efforts, and continuous improvement activities.
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Conduct onboarding, coaching, performance management, and ongoing staff development activities.
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Review and approve timecards and operational documentation as needed.
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Collaborate with leadership and clients regarding contractual requirements, operational processes, and reporting activities.
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Maintain a strong customer service focus while supporting organizational goals and accreditation standards.
Qualifications
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Associate degree (AA/AS)
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Current, active, unrestricted RN license
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5 years of direct patient care clinical experience
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1 year of utilization review or medical management experience
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Strong communication, problem-solving, organizational, and customer service skills
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Ability to lead teams in a remote work environment
Preferred Qualifications
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Bachelor’s degree (BA/BS)
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Prior supervisory or team leadership experience
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Experience working within managed care, healthcare consulting, or payer environments
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InterQual experience
Benefits
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Medical, dental, and vision insurance
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Paid time off for vacation, illness, and volunteering
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Retirement savings plan with employer contribution
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Adoption financial assistance
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Paid parental leave
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Annual remote work stipend
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And much more!
Company Description
Comagine Health is a national, mission-driven nonprofit healthcare consulting organization dedicated to improving health and healthcare quality across the United States. For more than 50 years, we have partnered with providers, payers, communities, and government organizations to improve patient outcomes and strengthen healthcare systems. Our talented remote workforce spans the country, and we actively support flexible remote work while fostering collaboration, innovation, and professional growth. We are committed to creating meaningful work that improves lives.
