Clinical Review Supervisor

VanderHouwen; United States; Remote; USD 80,000 - 113,000; Full time

Job summary

A leading healthcare consulting organization is seeking a Clinical Supervisor to manage personnel, ensure quality compliance, and enhance healthcare delivery systems. The ideal candidate will hold an active RN license and possess strong leadership and operational oversight skills. This remote position offers a robust salary range based on experience in medical management and customer service.

Qualifications

• Minimum 3 years in medical management and customer service.
• Strong leadership and organizational abilities required.
• Preferred 5 years of clinical experience and supervisory experience.

Responsibilities

• Conduct recruitment, onboarding, and training of staff.
• Ensure adherence to legal and accreditation standards.
• Oversee performance management and staff evaluations.

Skills

Leadership

Critical thinking

Decision-making

Communication

Interpersonal skills

Education

Current RN license

Certified Case Manager (CCM)

Job description

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This range is provided by VanderHouwen. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$80,000.00/yr - $113,000.00/yr

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Location: 100% Remote (can be remote in Alaska or any state in PST or MTZ)

About the company:

We are a leading healthcare consulting and quality improvement organization, dedicated to helping healthcare providers deliver high-quality care that improves patient outcomes. With a focus on innovation, collaboration, and data-driven solutions, we partner with healthcare organizations to enhance the effectiveness, efficiency, and safety of care delivery.

Our services include healthcare quality improvement, patient safety, value-based care solutions, and operational support to ensure that providers meet and exceed the evolving standards of healthcare. We work closely with clients to implement best practices, drive continuous improvement, and optimize healthcare delivery systems across a wide range of care settings.

Committed to making a meaningful impact in healthcare, we strive to create solutions that improve patient care, reduce disparities, and promote better health outcomes. By joining our team, you will be part of an organization that values integrity, teamwork, and the opportunity to transform the healthcare landscape.

• Conduct a range of personnel management activities including recruitment, selection, onboarding, training, performance evaluation, and separation, in accordance with organizational policy and in collaboration with Human Resources.
• Ensure delivery of initial orientation and ongoing training for direct reports, including thorough review of job descriptions.
• Provide access to necessary procedures, technology, and resources to support successful job performance; act as a subject matter expert when needed.
• Deliver timely, constructive feedback and recognition using objective, job-related metrics; initiate performance improvement plans as needed.
• Set and monitor professional development goals and delegate tasks appropriately.
• Establish and uphold performance expectations at both individual and team levels, applying the organization’s standards of conduct.

Operational and Clinical Oversight:

• Ensure the integrity and quality of utilization management services.
• Support the development and updating of organizational and contractual policies and review processes.
• Ensure clinical staff adherence to legal, contractual, and accreditation standards, as well as compliance with corporate policies.
• Accept utilization management assignments as needed to support high workloads or complex cases.
• Offer subject matter expertise on contractual and regulatory requirements in partnership with leadership.
• Coordinate team workflows to meet operational timelines and deliverables.
• Conduct quarterly and ad hoc audits to ensure adherence to established criteria.
• Provide 1:1 and group training based on staff performance to improve effectiveness and measure progress.
• Assist with internal quality control reviews and report preparation.
• Oversee new hire onboarding and training processes.
• Refer cases to internal or external professionals (e.g., behavioral health, medical consultants) as appropriate.
• Participate in candidate interviews and assist with the fair hearing process.
• Promote excellent customer service by modeling and reinforcing positive behaviors and communication.
• Keep management informed of significant issues including operational challenges, performance trends, complaints, compliments, quality initiatives, and staffing matters.
• Collaborate with Medical Affairs on complex case reviews and clinical discussions.
• Perform other duties as assigned.

Required Qualifications:

• Current, active, unrestricted Registered Nurse (RN) license (required)
• If performing case management work: Certified Case Manager (CCM) certification, or ability to obtain within two years of hire
• Minimum of 3 years in medical management
• Minimum of 3 years in customer service or relevant professional experience

Preferred Qualifications:

• 5 years of clinical (direct patient care) experience preferred
• At least 1 year of supervisory or lead experience preferred

Specialized Knowledge, Skills, and Abilities:

• Strong leadership, critical thinking, and decision-making skills
• Excellent organizational, communication, and interpersonal abilities
• In-depth understanding of Medicaid processes, policies, and quality control principles
• Experience with InterQual criteria is preferred

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Management and Analyst

• Industries

  Public Health and Health and Human Services

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