Supervisor, Clinical Quality Review

This is a fully remote position, open to applicants in Arizona, +16 more states.

📋 Description

• Oversees daily clinical review and medical record operations that support intricate, time-sensitive regulatory audits and quality initiatives.

• Provides direct oversight, coaching, and management of workloads for Clinical Quality Review RNs.

• Ensures that audit deliverables, documentation standards, and regulatory timelines are adhered to.

• Utilizes independent judgment to proactively identify operational risks, manage escalations, and adjust workflows in response to evolving audit requirements, data accessibility, and business priorities.

• Aids the Manager in maintaining an efficient departmental operation and workflow.

• Collaborates with other departments to ensure that workflows are sufficient to meet the demands of the project/audit.

• Guides staff through complex, ambiguous, or high-risk audit situations.

• Recognizes and assists in resolving escalated and/or intricate issues.

• Supports the department's daily operations and long-term planning.

• Works in partnership with the department and all business segments to guarantee consistent, effective, and timely communication.

• Assists with data collection and audit processes.

• Develops and/or contributes to training and training materials.

• Collaborates with HR to recruit and onboard new staff members.

• Enhances staff resilience and performance during peak audit periods.

• Balances productivity expectations with quality and compliance standards.

⛳️ Requirements

• Bachelor's degree or equivalent experience in a relevant field (Nursing preferred).

• 5 years of pertinent clinical healthcare experience beyond the degree, including extensive clinical practice or equivalent clinical review experience.

• Active Registered Nurse (RN) License is preferred.

• 2 years of previous experience in a Lead, Supervisor, or Clinical Leadership role.

• 4 years of comprehensive nursing or clinical experience, or a similar depth of experience in a clinically focused healthcare field.

• 2 years of experience in a managed care organization, ideally supporting quality improvement, clinical review, or regulatory audit activities.

• Proven experience managing clinical review, quality, or audit tasks under strict regulatory deadlines.

• Demonstrated knowledge of regulatory medical record documentation requirements, including: HEDIS and STARS Off‑Season Data Collection, CMS Cost Audits, RADV, and Clinical Data Validation.

• Familiarity with ICD‑10 and CPT coding.

🏝️ Benefits

• Competitive medical, dental, and vision plans.

• Paid Time Off (PTO).

• Holiday pay.

• Paid volunteer time off.

• 401K contributions.

• Caregiver services.