Clinical, Supervisor

Acentra; United States; Remote; USD 84,000 - 104,000; Full time

Job summary

Acentra Health is seeking a Clinical Supervisor (RN) to oversee Utilization Management activities and ensure contract requirements are met with high standards. The role emphasizes clinical program quality and customer relationship enhancement across our national operations.

The position requires an active RN license ( Indiana or compact), 2+ years in healthcare management, and 5+ years in a lead utilization/quality role.

Qualifications

• Active, unrestricted RN license in Indiana or compact license.
• Associate degree or equivalent in nursing, healthcare administration or related area.
• 2+ years of healthcare management experience.
• 5+ years in a lead position in quality and utilization management.
• Bachelor's degree preferred.
• Excellent verbal and written communication skills.
• Current knowledge of utilization management.
• Customer-focused and capable of building relationships with internal and external customers.
• Organizational skills with ability to plan and prioritize multiple assignments.
• Current InterQual and Milliman criteria knowledge.
• Experience with systems that support Utilization Review processing.
• Ability to lead teams and provide technical guidance.

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 including prior authorization and retro reviews.
• Serve as a Subject Matter Expert (SME).
• Participate in collaborative decision-making among leadership and diverse teams.
• Perform other duties as assigned.
• Read, understand, and adhere to HIPAA and Privacy/Security Rules.

Skills

RN license

Verbal communication

Written communication

Utilization management knowledge

Customer focus

Organizational skills

Team leadership

Microsoft Office

HIPAA awareness

Education

Associate degree or equivalent

Bachelor's degree preferred

Tools

InterQual criteria knowledge

Milliman criteria knowledge

Utilization Review systems

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 highstandards.
• 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 andretro 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 andits Privacy and Security Rules.

Qualifications

Required Qualifications

• Active, unrestricted Licensed RN in Indiana or compact license.
• Associate degree or equivalent directly applicable experience in nursing, healthcareadministration 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 relationshipswith 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 essentialto 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.