Supervisor – RN Clinical

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

📋 Description

• Oversee the daily functions of the clinical team within medical management operations.

• Ensure adherence to production metrics, service level agreements, contractual obligations, strategic goals, operational objectives, and budgetary constraints.

• Assist in the development and implementation of future-state initiatives and clinical quality programs.

• Identify operational enhancement opportunities and areas for process improvement within clinical product offerings.

• Provide strategic recommendations to leadership.

• Supervise and coordinate the daily tasks of business support, technical support, or production teams.

• Establish team priorities and collaborate with other supervisors and managers to coordinate work.

• Monitor operational performance, quality indicators, adherence to contractual obligations, execution of policies and procedures, and clinical appropriateness.

• Administer clinical programs, including medical policy and utilization management processes, ensuring compliance with contractual and regulatory requirements.

• Act as an escalation point for complex issues.

• Offer departmental leadership through mentoring, auditing, productivity monitoring, and coaching.

• Communicate with management regarding employee/HR concerns, department status updates, service-related issues, client matters, and legal-risk topics.

• Analyze data trends from reports to enhance quality, efficiency, and productivity.

• Provide insights on productivity and operational efficiency.

• Identify efficiencies in operations, process improvements, and best practices.

• Travel as required.

• Actively participate in both in-person and virtual internal and external meetings.

• Supervise a team of 1–20 direct reports.

⛳️ Requirements

• Bachelor’s degree in a relevant field or equivalent experience.

• 2–5 years of relevant experience, or a master's degree.

• Registered Nurse License in good standing in the state of employment and/or cross-licensed in other states.

• Telephonic nursing positions require a Compact State License in eligible states, with a willingness to obtain such a license when necessary.

• Telephonic nursing roles require a California State License, with a readiness to acquire additional single-state licenses upon request.

• Proficient PC navigation skills.

• Familiarity with Microsoft Office.

• Exceptional verbal and written communication and presentation abilities.

• Strong understanding of the health insurance sector.

• Capable of navigating and supporting public and private insurance/plan requirements.

• Experience in managed care settings.

• Knowledge of, or ability to implement, utilization management principles.

• Demonstrated leadership in a clinical operations context.

• Willingness to travel as necessary.

• Supervisory experience overseeing 1–20 direct reports.

🏝️ Benefits

• Remote work opportunities.

• Competitive salary packages.

• Opportunities for career advancement.

• 401K plan with company matching.*

• Tuition reimbursement available after 90 days of employment.

• Flexible work environment.

• Discretionary Paid Time Off (PTO).

• Paid holidays.

• Employee assistance programs.

• Comprehensive medical, dental, and vision insurance.

• Health Savings Account (HSA) and Flexible Spending Account (FSA) options.

• Telemedicine services (virtual doctor appointments).

• Wellness programs.

• Adoption assistance.

• Short-term disability benefits (available after 90 days of employment).

• Long-term disability coverage.

• Life insurance options.

• Various discount programs.