[Hiring] Supervisor of Clinical Review @Acentra Health, LLC

Role Description

Acentra Health is looking for a Supervisor of Clinical Review to join our growing team. As Supervisor of Clinical Review, this individual plays a pivotal role in overseeing and managing the Utilization Management (UM) activities within the organization. With a strong clinical foundation and leadership acumen, the Clinical Supervisor ensures that UM processes are executed efficiently, consistently, and in alignment with regulatory and contractual standards.

• Lead and oversee all Utilization Management (UM) activities including prior authorization and ensuring accuracy, consistency, and timely completion.
• Conduct utilization reviews as needed to support workload demands and program requirements.
• Monitor daily work queues and adjust staffing schedules to align with departmental demands.
• Evaluate productivity and performance metrics of nurse reviewers to maintain high standards of efficiency and quality.
• Identify onboarding and ongoing learning needs for Clinical Reviewers; collaborate with leadership to design and implement effective development plans.
• Actively participate in leadership meetings, committees, and cross-functional workgroups to promote shared decision-making and continuous improvement.
• Oversee quality assurance activities such as audits, Quality Improvement Plans (QIPs), database management, and Inter-Rater Reliability (IRR) support.
• Identify areas for process and clinical improvements; develop and execute action plans to enhance outcomes.
• Serve as a liaison to customers and providers, ensuring timely resolution of issues and promoting service excellence.
• Stay current with clinical best practices and UM protocols, act as the primary resource for nurse reviewers regarding clinical review inquiries.
• Support departmental and organizational goals by performing additional 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 RN or LPN/LVN license.
• A minimum of 2+ years of experience as a practicing RN or LPN/LVN.
• A minimum of 1 year of experience leading, coaching, and developing staff in a healthcare environment, including at least 1 year in Utilization Management.
• A minimum of 1+ years of experience applying InterQual and/or MCG clinical criteria in utilization review processes.
• Strong verbal and written communication skills, with the ability to convey complex information clearly and professionally.
• Demonstrated customer-centric approach with a focus on achieving results and fostering positive relationships with internal and external stakeholders.
• Excellent organizational and time management skills, with the ability to prioritize multiple tasks effectively.
• Proven ability to work both independently and collaboratively within a team environment.
• Proficiency in Microsoft Office Suite and other relevant software applications essential to the role.

Requirements

• Associate degree or equivalent experience directly applicable to clinical practice (preferred).
• Bachelor's degree (preferred).
• Ability to provide technical guidance and leadership support to management and clinical teams (preferred).

Benefits

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