[Hiring] Clinical Supervisor @Acentra Health, LLC

Role Description

Acentra Health is looking for a Clinical Supervisor (RN) to join our growing team. The Clinical Supervisor will oversee and manage the Utilization Management activities, focusing on maintaining high standards in clinical programs and enhancing customer relationships to ensure contract requirements are met successfully.

• Manage and oversee Utilization Management activities.
• Ensure overall consistency, thoroughness, and accuracy of clinical programs.
• Oversee program to ensure clinical efficiencies, deliverables, and contract functions meet high standards.
• Strengthen relationships with customers and meet contract requirements.
• Provide day-to-day oversight to manage the utilization review program.
• Responsible for utilization reviews as defined by the contract to include prior authorization and retro reviews.
• Serve as a Subject Matter Expert (SME).
• Participate as a team member fostering collaborative decision-making among leadership, committees, teams, or work groups of diverse composition.
• Perform other duties as assigned.
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.

Qualifications

• Active, unrestricted Licensed RN in Indiana or compact license.
• Associate degree or equivalent directly applicable experience in nursing, healthcare administration or related area.
• 2+ years of health care management experience.
• 5+ years of experience in a lead position in a quality and utilization management program.

Requirements

• Bachelor's degree preferred.
• Excellent verbal and written communication skills essential.
• Current working knowledge of utilization management.
• Customer-focused, results-oriented, and capable of building and maintaining relationships with internal and external customers.
• Organizational skills, ability to plan and prioritize multiple assignments essential.
• Current InterQual and Milliman criteria knowledge.
• Experience in using systems that support Utilization Review processing.
• Ability to work in team setting and independently.
• Computer proficiency in Microsoft Office applications and other software programs essential to perform job functions.
• Ability to provide technical guidance and leadership to management team.

Benefits

• Comprehensive health plans.
• Paid time off.
• Retirement savings.
• Corporate wellness.
• Educational assistance.
• Corporate discounts.
• And more.