Clinical, Supervisor

Acentra Health; United States; On-site; USD 84,000 - 92,000; Full time

Job summary

Acentra Health in the United States seeks a Clinical Supervisor (RN) to lead utilization management initiatives, ensuring contract requirements are met while delivering high-quality clinical programs. The role focuses on maintaining standards, strengthening customer relationships, and guiding a team through complex reviews.

You will collaborate with stakeholders, oversee prior authorizations and retro reviews, and act as a subject matter expert.

Qualifications

• Active, unrestricted RN license in Indiana or a compact license.
• Associate degree or equivalent in nursing, healthcare administration, or related area.
• 2+ years of health care management experience.
• 5+ years in a lead role within quality and utilization management.

Responsibilities

• Oversee Utilization Management activities and ensure program integrity.
• Maintain high standards for clinical programs and customer relationships to meet contract requirements.
• Provide day-to-day oversight of the utilization review program, including prior authorizations.
• Serve as SME and guide leadership and cross-functional teams.
• Ensure HIPAA/privacy compliance and adherence to corporate policies.

Skills

Leadership

Communication

Team collaboration

Education

Active RN license (IN or compact)

Associate degree or related experience

Job description

Company Overview

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

At Acentra Health, we embrace emerging technologies, including artificial intelligence and advanced analytics that can be utilized to improve processes, enhance decision-making, and drive better health outcomes. We value professionals who are curious about new technologies and motivated to use innovative tools to increase efficiency, quality, and impact in their roles.

Job Summary And Responsibilities

Acentra Health is looking for a Clinical, Supervisor to join our growing team.

Job Summary

The Clinical Supervisor (RN) role will oversee and manage the Utilization Management activities. One of their primary focus will be to maintain a high-standards in clinical programs and enhance customer relationships to ensure contract requirements are met successfully.

Responsibilities

• Manage and oversee Utilization Management activities.
• Ensure overall consistency, thoroughness, and accuracy of clinical programs.
• Oversee program to ensure clinical efficiencies, deliverables, and contract functions meet high standards.
• Strengthen relationships with customers and meet contract requirements.
• Provide day-to-day oversight to manage the utilization review program.
• Responsible for utilization reviews as defined by the contract to include prior authorization and retro reviews.
• Serve as a Subject Matter Expert (SME).
• Participate as a team member fostering collaborative decision-making among leadership, committees, teams, or work groups of diverse composition.
• Perform other duties as assigned.
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.

The list of accountabilities is not intended to be all-inclusive and may be expanded to include other education- and experience-related duties that management may deem necessary from time to time.

Qualifications

Required Qualifications

• Active, unrestricted Licensed RN in Indiana or compact license.
• Associate degree or equivalent directly applicable experience in nursing, healthcare administration or related area.
• 2+ years of health care management experience
• 5+ years of experience in a lead position in a quality and utilization management program.

Preferred Qualifications

• Bachelor's degree preferred
• Excellent verbal and written communication skills essential.
• Current working knowledge of utilization management.
• Customer-focused, results-oriented, and capable of building and maintaining relationships with internal and external customers.
• Organizational skills, ability to plan and prioritize multiple assignments essential.
• Current InterQual and Milliman criteria knowledge.
• Experience in using systems that support Utilization Review processing.
• Ability to work in team setting and independently.
• Computer proficiency in Microsoft Office applications and other software programs essential to perform job functions.
• Ability to provide technical guidance and leadership to management team.

Why us?

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

We do this through our people.

You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

Benefits

Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

EEO AA M/F/Vet/Disability

Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.

Experience In Lieu Of Degree

For non-clinical roles, or when not required by the contract specifically, the Company acknowledges that practical, hands-on experience can provide skills and competencies equivalent to formal education. As such, in cases where a Bachelor's degree may be required, the Company will accept a minimum of six (6) years of directly relevant professional experience in lieu of a degree. In instances where the candidate has an Associate's degree, the Company will accept a minimum of three (3) years of directly relevant professional experience in lieu of the Bachelor's degree.

Compensation

The pay for this position is listed below.

$83,520 - $92,000

"Based on our compensation philosophy, an applicant’s position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level."

Pay Range

USD $83,520.00 - USD $104,400.00 /Yr.