Remote Clinical Review Supervisor - Utilization & Quality

Comagine Health; Northern (KY); Hybrid; USD 90,000 - 107,000; Full time

Benefits offered by this job

Medical insurance

Paid time off

Retirement plan

Job summary

Comagine Health in Oregon is seeking a Supervisor, Clinical CM to provide operational supervision of clinical staff performing utilization reviews and specialty reviews using InterQual criteria. You will mentor reviewers, ensure medical necessity decisions are accurate, and maintain regulatory compliance while coordinating with internal and external stakeholders.

This role supports a flexible remote work model with occasional on-site collaboration, based out of Oregon, serving diverse healthcare

Qualifications

• 5 years of direct patient care clinical experience
• 1 year of utilization review or medical management experience
• Strong communication and leadership skills
• Ability to lead teams in a remote work environment
• Graduate degree in social work or nursing with behavioral health training

Responsibilities

• Conduct utilization reviews using InterQual and organizational policies
• Supervise utilization management and care coordination activities
• Escalate complex clinical issues to leadership
• Support quality improvement, audits, and staff development
• Onboard, coach, and manage performance of staff
• Review timecards and documentation; assist with reporting
• Collaborate with clients on contractual requirements and processes
• Maintain strong customer service aligned with accreditation standards

Skills

Clinical supervision

Utilization review

Behavioral health

Education

Master of Social Work (MSW)

BSN (Nursing)

Tools

InterQual

Job description

Comagine Health in Oregon is seeking a Supervisor, Clinical CM to provide operational supervision of clinical staff performing utilization reviews and specialty reviews using InterQual criteria. You will mentor reviewers, ensure medical necessity decisions are accurate, and maintain regulatory compliance while coordinating with internal and external stakeholders.

This role supports a flexible remote work model with occasional on-site collaboration, based out of Oregon, serving diverse healthcare