Supervisor, Clinical Review D.C.

Comagine Health; Washington (District of Columbia); Hybrid; USD 84,000 - 120,000; Full time

Job summary

An established industry player is seeking a Supervisor for Clinical Review to join their team in D.C. This role involves operational supervision of clinical staff, guiding them in conducting utilization reviews. The ideal candidate will possess a Bachelor's degree and a current RN license, along with significant experience in medical management and customer service. This position offers the opportunity to make a meaningful impact in health care delivery, ensuring compliance with legal and accreditation standards while fostering a collaborative environment. If you're passionate about improving health care systems, this role is perfect for you.

Qualifications

• 3 years of medical management and customer service experience.
• Current District of Columbia Registered Nurse licensure required.

Responsibilities

• Oversee clinical staff conducting utilization reviews and specialty reviews.
• Conduct personnel management activities including recruitment and training.

Skills

Medical Management

Customer Service

Clinical Supervision

Education

Bachelor's Degree in a Related Field

Registered Nurse Licensure

Job description

Supervisor, Clinical Review D.C.

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Category

Care Management

Job Location

District of Columbia

Tracking Code

134764

Industry

Select Industry

Job Level

Junior Management

Position Type

Full-Time/Regular

Years of Experience

Not Applicable

Comagine Health is seeking a remote/hybrid Supervisor Clinical Review position to join the team on the D.C. Contract. The Supervisor Clinical Review will provide operational supervision of clinical staff who conduct utilization review and/or specialty reviews. This position will guide and train clinical reviewers (nurses and dental hygienists) to identify medical necessity appropriateness.

Candidates who reside in Washington D.C., Maryland, or Virginia are preferred.

Who is the Comagine Health?

Comagine Health is a national, nonprofit, health care consulting firm. We work collaboratively with patients, providers, payers, and other stakeholders to reimagine, redesign and implement sustainable improvements in the health care system.

As a trusted, neutral party, we work in our communities to address key, complex health, and health care delivery problems. In all our engagements and initiatives, we draw upon our expertise in quality improvement, care management, health information technology, analytics, and research.

We invite our partners and communities to work with us to improve health and redesign the health care delivery system.

Some of what you'll do:

• Conduct a variety of personnel management activities, including but not limited to recruitment, selection, on-boarding, training, evaluation, and separation, according to Comagine Health policy and practice and in collaboration with leadership and Human Resources.


• Deliver, or ensure delivery, of initial orientation and training (including review of direct reports' job descriptions), plus on-going training.


• Ensure availability of procedures, technology, and other resources necessary to conduct work activities; provide subject matter expertise as applicable.


• Provide timely, continuous recognition and feedback using objective, job-related data, and observations (including documented performance appraisals); timely initiates performance improvement opportunities in alignment with Comagine Health policy and practice.


• Develop and monitor professional development goals and objectives; assign work and delegate authority appropriate for established, job-related duties, responsibilities, and qualifications.


• Assist with developing and updating Organizational/ contractual policies and review process.


• Ensure that Clinical staff meets all required legal, contractual, and accreditation standards and compliance with corporate policies.


• Accept utilization management assignments when work volumes or case complexities require supervisory intervention and support.


• Provide subject matter expertise on contractual provisions and relevant regulations in conjunction with the manager.


• Coordinate the team's workflow and operations to ensure timeliness and deliverables.


• Conduct informal audits quarterly and ad hoc to ensure adherence to criteria.


• Perform 1:1 training, group training based on staff performance to measure progress and training effectiveness.


• Assist with report preparation and internal quality control review.


• Administer new hire onboarding activities and training.


• Refer cases to other professionals internally, including behavioral health team and medical consultation, and other appropriate external sources, when indicated.


• Participate in candidate interviews.


• Assist with fair hearing process.


• Promote, monitor, and improve positive customer service behaviors, communications, and attitudes by all staff in the provision of services to all stakeholders.


• Ensure that Manager or designee is informed in a timely manner regarding significant operational issues, performance measures, complaints/grievances, compliments, quality management initiatives, staffing concerns, and other relevant topics.


• Collaborate with Medical Affairs for complex case review and clinical topics.

Required Qualifications:

• Bachelor's degree in a related field (equivalent combination of education and/or work experience in related field may be substituted.)


• Current, active, unrestricted District of Columbia Registered Nurse licensure.


• 3 years of medical management experience.


• 3 years of customer service or other relevant work experience.

Candidates who reside in Washington D.C., Maryland, or Virginia are preferred.

Desired Qualifications:

• 5 years of clinical (direct patient care) experience.


• 1 year of supervisory or lead experience.

Compensation Range:

$84,000 - $120,000

Geographical location considered in compensation range.