RN Clinical Review Supervisor — Lead Medical Utilization (AL)

Comagine Health; Sacramento (CA); On-site; USD 85,000 - 110,000; Full time

Benefits offered by this job

Medical, dental and vision insurance

Paid time off

Retirement savings plan

Adoption financial assistance

Paid parental leave

Job summary

Comagine Health seeks an experienced Supervisor, Clinical Review to oversee clinical staff performing utilization reviews. The role requires active RN licensure and Alabama residency, guiding reviewers to assess medical necessity and ensure adherence to established criteria.

The position emphasizes leadership, training, and collaboration with care teams, with a focus on regulatory compliance and quality improvement in a healthcare setting.

Qualifications

• RN licensed in Alabama and in good standing.
• Experience with PA reviews and utilization review preferred.
• Strong knowledge of clinical review processes and healthcare regulations.
• Proficiency with EMR systems and clinical documentation standards.

Responsibilities

• Provide operational supervision of clinical staff conducting utilization and specialty reviews.
• Guide, monitor and train reviewers to identify medical necessity and appropriateness.
• Lead process improvement and ensure compliance with criteria and contract guidelines.

Skills

Supervisory experience

Clinical review knowledge

EMR proficiency

Regulatory knowledge

Leadership

Education

RN license in Alabama

Job description

Comagine Health seeks an experienced Supervisor, Clinical Review to oversee clinical staff performing utilization reviews. The role requires active RN licensure and Alabama residency, guiding reviewers to assess medical necessity and ensure adherence to established criteria.

The position emphasizes leadership, training, and collaboration with care teams, with a focus on regulatory compliance and quality improvement in a healthcare setting.