Quality Assurance Supervisor – Clinical RN

This is a fully remote position, open to applicants in Florida.

📋 Description

• The Supervisor of Quality Assurance (Clinical) utilizes their nursing expertise, clinical review skills, and leadership experience to oversee the performance and operational outcomes of a remote team comprising nurses and other audit positions, conducting clinical review audits.

• Fosters a positive team atmosphere that encourages open communication, information sharing, continuous improvement, and enhanced business performance.

• Regularly conducts quality assurance audits to supplement the QA team's activities as needed based on business requirements or special projects.

• Aids in the resolution of quality review disputes.

• Proactively identifies and suggests cost-saving measures and outcome improvements that can directly influence the company's profitability.

• Contributes effectively to the establishment of medical review guidelines and associated training.

• Assists audit management and segment specialists with the implementation of new concepts and the upkeep of medical review guidelines for existing concepts.

• Leverages data, reports, and experience to detect potential backlogs and allocate resources to meet business demands and service level agreements (SLAs).

• Works collaboratively with other departments to address operational challenges.

• Monitors team activities and ensures alignment with management to maintain necessary staffing levels for assigned business segment objectives.

• Provides necessary support to ensure that auditors have the tools and resources required for audit tasks.

• Oversees the daily functions of the quality assurance team.

• Offers audit guidance to the QA team; identifies trends and proposes solutions.

• Generates production and quality performance reports, providing coaching and constructive feedback to team members.

• Manages team Time and Attendance (including time off, accrual usage, attendance points, and timecards for hourly staff) in compliance with relevant policies and procedures.

• Collaborates with HR for applicable corrective actions as necessary.

• Completes and conducts performance evaluations for assigned staff.

• Regularly reviews QA scorecards for accuracy and educational purposes, ensuring quality assurance of the QA process.

• Holds regular team meetings with direct reports.

• Provides leadership to team members, offering solutions and resolving conflicts.

• Escalates issues to management and collaborates with HR as necessary to implement appropriate solutions for employee matters.

• Delivers reports and updates to management as required to reflect operational and staff activities and results.

• Participates in and contributes to relevant departmental meetings.

• May assist management in monitoring the inventory and activities of third-party/subcontractors.

• Becomes a subject matter expert for designated business segment(s).

• Maintains up-to-date knowledge of industry changes affecting our clients and the medical field, including practice, technology, regulations, legislation, and business trends.

• May support the development of training materials/tools and best practices.

• Identifies training needs and ensures the team receives necessary education.

• Facilitates training activities for new auditors or provides supplemental training for existing staff as required.

• Accepts feedback and adjusts priorities for themselves and the team as needed.

• Leads by example and performs work in accordance with company policies, governmental regulations, and laws.

• Acts as a positive role model and embodies characteristics that support and enhance a collaborative culture of continuous improvement and high-performing teams.

• Performs other incidental and related duties as required and assigned to fulfill business needs.

⛳️ Requirements

• A minimum of 3 years of diverse nursing experience providing direct care in either an inpatient or outpatient setting.

• A current active unrestricted nursing license in good standing is required (RN license is necessary for positions focused on government contracts).

• Must not be currently sanctioned or excluded from the Medicare program by the OIG.

• At least 2 years of experience conducting medical record audits or quality reviews in either a provider or payer setting for a health insurance company.

• Proven experience in gathering, researching, and documenting data and requirements for projects and/or complex problem-solving.

• 3+ years of prior supervisory or leadership experience in a similar business environment (preferably overseeing remote staff).

• At least 3 years of experience in healthcare claims, demonstrating expertise in DRGs and medical billing for an insurance company or hospital required. (Less than 3 years may be considered for internal candidates based on demonstrated skills and results).

• Medical coding certification is an advantage.

• Previous experience in payer edit development or reimbursement policy is a plus.

🏝️ Benefits

• Medical, dental, vision, HSA/FSA options

• Life insurance coverage

• 401(k) savings plans

• Family/parental leave

• Paid holidays

• Paid time off annually