Supervisor, Clinical CM

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

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Supervisor, Clinical CM

OR, US

2 days ago Requisition ID: 1155

Salary Range: $90,000.00 To $107,000.00 Annually

Who is Comagine Health?

Comagine Health is a national, mission-driven nonprofit healthcare consulting organization dedicated to improving health and healthcare quality across the United States. For more than 50 years, we have partnered with providers, payers, communities, and government organizations to improve patient outcomes and strengthen healthcare systems.

Our talented remote workforce spans the country, and we actively support flexible remote work while fostering collaboration, innovation, and professional growth. We are committed to creating meaningful work that improves lives.

We believe in an environment that allows you to thrive personally and professionally. Benefits include:

• Medical, dental, and vision insurance
• Paid time off for vacation, illness, and volunteering
• Retirement savings plan with employer contribution
• Paid parental leave
• And much more!

Position Summary

The Clinical Review Supervisor provides operational supervision of clinical staff conducting utilization review and specialty review activities. This role is responsible for guiding, training, and supporting clinical reviewers to ensure accurate determinations regarding medical necessity, quality, and appropriateness of healthcare services.

The supervisor also supports operational excellence through quality oversight, staff development, regulatory compliance, and collaboration with internal and external stakeholders.

This position is based out of Oregon.

Key Responsibilities

• Conduct prospective, concurrent, retrospective, and pre-authorization utilization reviews using InterQual, an evidence-based clinical criterial tool, organizational policies, and regulatory guidelines
• Supervise utilization management, care coordination, and/or case management activities to ensure quality, compliance, timeliness, and contractual performance standards are met
• Serve as an escalation point for complex clinical or operational concerns and communicate significant issues to leadership appropriately
• Support quality management initiatives, audits, training efforts, and continuous improvement activities
• Conduct onboarding, coaching, performance management, and ongoing staff development activities
• Review and approve timecards and operational documentation as needed
• Collaborate with leadership and clients regarding contractual requirements, operational processes, and reporting activities
• Maintain a strong customer service focus while supporting organizational goals and accreditation standards

Qualifications

Required

Current, active, unrestricted Oregon LPC, LCSW, LMFT or RN (with Behavioral Health experience) licensure

• 5 years of direct patient care clinical experience
• 1 year of utilization review or medical management experience
• Strong communication, problem-solving, organizational, and customer service skills
• Ability to lead teams in a remote work environment
• Graduate degree in social work, psychology, or other behavioral
  health science field or;
• Bachelor’s degree in nursing and licensed by the State of Oregon
  (with relevant training in behavioral health service delivery)

Preferred

• Prior supervisory or team leadership experience
• Experience working within managed care, healthcare consulting, or payer environments
• InterQual experience

Equal Opportunity Employer

Comagine Health is an equal opportunity employer and is committed to creating a diverse, equitable, and inclusive workplace.