RN Supervisor of Clinical Review

Job Summary

Leading the Utilization Management activities, the full-time remote Supervisor of Clinical Review will oversee clinical review processes, manage staff performance, and ensure compliance with regulatory standards while fostering strong relationships with stakeholders.

Key responsibilities:

• Lead and manage all Utilization Management activities, including prior authorizations and utilization reviews
• Monitor staffing schedules and productivity metrics while identifying training needs for Clinical Reviewers
• Participate in leadership meetings and quality assurance activities to promote continuous improvement and service excellence

Required qualifications:

• Active, unrestricted RN or LPN/LVN license
• Minimum of 2+ years of experience as a practicing RN or LPN/LVN
• At least 1 year of experience in a leadership role within a healthcare environment, including Utilization Management
• 1+ years of experience with InterQual and/or MCG clinical criteria in utilization review processes
• Proficiency in Microsoft Office Suite and relevant software applications