Medical Review Supervisor

This is a fully remote position, open to applicants in Alabama, +3 more states.

📋 Description

• Oversee and manage the daily operations of Utilization Review/Review Nurses, Case Management, and/or Medical Review teams, as well as specialty programs.

• Ensure that appropriate healthcare service levels are maintained.

• Direct the everyday activities of assigned personnel.

• Recognize training requirements and confirm the accuracy and timeliness of workflow processes.

• Supervise employees, including approving time off, leave requests, performance assessments, and related tasks.

• Recruit, train, and inspire staff to deliver outstanding customer service.

• Conduct quality control measures for completed work.

• Create work plans aimed at enhancing quality performance.

• Compile, assess, and manage weekly and monthly reports.

• Formulate, sustain, and revise procedures and documentation for audit processes.

• Establish and communicate departmental standards and staff expectations.

• Coordinate special assignments and improvements in system testing.

⛳️ Requirements

• Associate's degree in a relevant field.

• Graduate from an Accredited School of Nursing.

• A minimum of 5 years of clinical experience or 5 years in utilization review/medical review (with at least 3 of those years being clinical).

• 1 year in a team lead/leadership position or equivalent military experience at grade E4 or higher (may overlap with the 5 years).

• Proficient in word processing, spreadsheet, and database software.

• Capable of working independently, prioritizing tasks effectively, and making informed decisions.

• Familiarity with managed care and/or diverse healthcare delivery systems.

• Strong clinical background including experience in home health, rehabilitation, and/or extensive medical surgical experience.

• Awareness of specific criteria/protocol sets and their application.

• Strong judgment abilities.

• Proven customer service, organizational, and presentation skills.

• Demonstrated proficiency in spelling, punctuation, and grammar.

• Ability to persuade, negotiate, or influence others effectively.

• Possess analytical or critical thinking capabilities.

• Skilled in handling confidential or sensitive information with care.

• Ability to lead, motivate, and evaluate the performance of team members.

• Proficient in Microsoft Office.

• Active, unrestricted RN license from the United States and in the state of employment, or an active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC).

• Preferred: Bachelor's degree in nursing (BSN), Master's degree in nursing (MSN), or MSN in Nursing Education.

• Preferred: Three years of experience in utilization/medical review, quality assurance, or home health, alongside 5 years of clinical experience.

• Experience with PA & RCD Programs, FISS, MCS.

• Knowledge of Medicare and/or relevant regulations/policies/instructions/provisions, home health, and/or medical review system/processing procedures.

• Exceptional presentation skills.

• Proficient in Microsoft Excel, Access, or other spreadsheet database tools.

• Sponsorship: This position does not qualify for sponsorship at this time or in the future.

🏝️ Benefits

• Subsidized health plans, along with dental and vision coverage.

• 401k retirement savings plan with company matching contributions.

• Life Insurance coverage.

• Paid Time Off (PTO) benefits.

• On-site cafeterias and fitness centers available in major locations.

• Education Assistance programs.

• Service Recognition initiatives.

• National discounts for movies, theaters, zoos, theme parks, and more.