Clinical Supervisor - UM - Commercial

CareCentrix; United States; Remote; USD 80,000 - 100,000; Full time

Job summary

A leading healthcare company is seeking a Utilization Management Clinical Supervisor to oversee Home Health activities. This role involves ensuring compliance with clinical guidelines, training staff, and collaborating across departments to improve operational processes. The ideal candidate will have a nursing license and extensive experience in healthcare delivery and management. The position offers benefits like health insurance, PTO, and opportunities for professional growth.

Benefits

Health Insurance

Dental Insurance

Vision Insurance

401K

Paid Parental Leave

Virtual Fitness Training

Tuition Reimbursement

Walgreens Discounts

Qualifications

• 5 years of healthcare delivery, managed care, and process improvement experience.
• 1 year of management and leadership experience.

Responsibilities

• Oversee Home Health activities and ensure compliance with standards.
• Collaborate with departments to implement best practices.
• Conduct training needs analysis and educate team members.

Skills

Communication

Organizational Skills

Critical Thinking

Education

Registered Nurse/LPN/LVN License

Job description

Overview

The Utilization Management (UM) Clinical Supervisor of the Home Health team oversees the department’s activities, including serving as a resource for the utilization management program and clinical guideline application. Responsibilities include assisting with clinical data collection, analysis, and reporting; supporting operations and management with clinical feedback and utilization training; tracking and monitoring turnaround times to ensure service requirements are met; coordinating with operations and clinical team members to intervene when service levels are at risk; providing issue resolution and escalation when necessary; ensuring timely letter generation and mailing; and coordinating with the Quality Department for audits. The UM Clinical Supervisor ensures compliance with customer, regulatory, and accrediting standards, as well as CareCentrix policies. The role involves training new team members, ongoing training of existing staff, monitoring performance, and working under general supervision.

Responsibilities

In this Job you will:

• Possess excellent communication (verbal/written), organizational, and interpersonal skills.
• Manage multiple tasks, be detail-oriented, responsive, and demonstrate independent thought and critical thinking.
• Supervise Home Health activities, including clinical consultation, case elevation for physician review, data collection, analysis, reporting, tracking, issue resolution, and turnaround time compliance.
• Collaborate with multiple departments to develop and implement best practices and operational processes that drive improvements and ensure compliance with policies, customer requirements, legal, and regulatory standards.
• Maintain standardized operations processes to ensure ongoing compliance.
• Work with Workforce Management and Quality departments to define and implement performance measures and standards.
• Oversee team impacts related to new clients or processes, conduct training needs analysis, and educate team members on updates.
• Participate in company initiatives, including BRDs, Project Charters, process development, and training activities.
• Perform coaching sessions regularly for professional development, address errors or audits, and develop team leads. Document all coaching in Quantum.
• Collaborate with HR and Talent Acquisition to recruit and develop a high-performing team.
• Attend staff development programs and obtain required continuing education.
• Interact with referral sources to facilitate communication, answer questions, and resolve escalations.
• Implement and maintain operational processes to ensure compliance with policies and regulations.
• Perform other duties as assigned.

This is the job for you if:

• You can participate in staff development and continuing education as required.
• You have experience in implementing and maintaining operational processes adhering to policies and regulations.
• You are willing to participate in special projects and perform additional duties as assigned.

Qualifications

You should get in touch if:

• You hold an active Registered Nurse/LPN/LVN license in any U.S. state or jurisdiction.
• You have at least five years of healthcare delivery, managed care, utilization management, case management, and process improvement experience.
• You possess at least one year of management and leadership experience.
• You are experienced with Utilization Management and regulatory standards.

What we offer:

• Benefits including health, dental, vision, HSA contributions, and dependent care FSA employer match.
• PTO, 401K, paid parental leave, virtual fitness training, and more.
• Opportunities for advancement, professional training, and tuition/exam reimbursement.
• PayActiv, Walgreens discounts, and a supportive company culture.

CareCentrix maintains a drug-free workplace.

#IDCC

We are an equal opportunity employer, making employment decisions without regard to protected categories.

Applications are accepted on an ongoing basis until a suitable candidate is found.