Supervisor, Clinical Review Alabama

COMAGINE HEALTH; Washington (District of Columbia); On-site; USD 90,000 - 120,000; Full time

Benefits offered by this job

Medical, dental and vision insurance

Paid time off for vacation, illness, &

Retirement savings plan with employer

Adoption financial assistance

Paid parental leave

Job summary

Comagine Health is seeking an active RN based in Alabama for a Supervisor, Clinical Review role. You will supervise clinical reviewers performing utilization and specialty reviews, ensuring medical necessity and adherence to criteria and contract guidelines.

The position requires strong leadership, EMR proficiency, and regulatory knowledge, with responsibilities including training, performance coaching, and collaboration with cross-functional teams.

Qualifications

• Active RN license in Alabama in good standing with the Alabama Board of Nursing and Board of Medical Examiners.
• Minimum 3 years of clinical experience in healthcare settings.
• At least 1 year of supervisory or team leadership experience in a clinical environment.

Responsibilities

• Provide operational supervision of clinical reviewers conducting utilization and specialty reviews.
• Guide, monitor, and train staff to assess medical necessity per criteria and contract guidelines.
• Demonstrate leadership to meet targets and drive process improvements.

Skills

Clinical leadership

Supervisory experience

Medical terminology

Regulatory knowledge

Communication

Education

RN license (Alabama)

Tools

EMR systems

Clinical documentation

Job description

About Company:

Why Comagine Health? Comagine Health is a national, mission-driven, nonprofit organization that has engaged in health care quality consulting and quality improvement services for more than 50 years. We are leaders in assisting front-line providers and engaging health care partners to improve care delivery and patient outcomes. Our talented remote workforce spans the country and plays a vital role in our success. We go beyond merely providing a remote work option; we support and embrace it. We offer opportunities to make a difference from anywhere in the U.S. and enjoy better work-life balance. An annual stipend gives you the freedom to enhance your workspace with options that suit your needs. We believe in an environment that allows you to thrive both personally and professionally. That's why we offer benefits that include:

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

Comagine Health actively cultivates an organizational culture that fosters well-being and prioritizes engagement, connectedness and collaboration among team members. Each employee's unique background, perspective and abilities are fundamental to the success of our mission and organization. Comagine Health is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability. We are proud to be a Recovery Friendly Workplace, supporting the health and well-being of all employees.

About the Role:

This role requires that the employee is an active RN and based in Alabama. The Supervisor, Clinical Review plays a critical role in providing operational supervision of clinical staff who conduct utilization review and/or specialty reviews. The Clinical Review supervisor will guide and monitor, and train clinical reviewers to identify medical necessity/medical appropriateness as identified by identified criteria, specific contract guidelines, and/or organizational clinical criteria.

Minimum Qualifications

• All nurse reviewers will be located and licensed within Alabama and in good standing with the Alabama Board of Nursing and Board of Medical Examiners.
• Experience with:Performing PA reviewsLong-term care including nursing home, ICF/IID, swing bed, PEC, and inpatient psychiatric facilitiesMinimum of 3 years of clinical experience in a healthcare setting.
• At least 1 year of supervisory or team leadership experience in a clinical environment.
• 1 year of medical management / utilization review experience Strong knowledge of clinical review processes, healthcare regulations, and medical terminology.
• Proficiency with electronic medical records (EMR) systems and clinical documentation standards.

Preferred Qualifications

• LCSW, LPC licensure or equivalent clinical certification.
• 3 years of medical management / utilization review experience
• Experience with health plan operations or managed care organizations.
• Familiarity with state and federal healthcare regulations, including HIPAA and CMS guidelines.
• 5 years of clinical (direct patient care) experience.

Responsibilities:

The supervisor, will display, critical thinking abilities, strong leadership skills, wise decision-making abilities, organized, knowledgeable and excellent communicator.Demonstrated leadership ability within a team, including management of personnel, meeting targets, and facilitating process improvement efforts.Competent in understanding medical/clinical terminology, diagnoses, and documentation

Skills:

The required skills enable the supervisor to effectively lead clinical review teams by applying clinical knowledge to evaluate patient care documentation and ensure compliance with healthcare standards. Strong communication and interpersonal skills are essential for collaborating with multidisciplinary teams and resolving clinical issues efficiently. Analytical skills are used daily to interpret clinical data, identify trends, and implement quality improvement initiatives. Proficiency with EMR systems and clinical software supports accurate documentation review and reporting. Preferred skills such as advanced certifications and familiarity with regulatory frameworks enhance the supervisor's ability to navigate complex healthcare environments and drive continuous improvement in clinical review processes.

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