$83,000–$107,000 Per Year
Accreditation Standards, Auditing, Case Management, Clinical Medicine, Clinical Support, Clinical Training, Coaching, Communication Skills, Consulting, Continuous Improvement, Contract Requirements, Customer Support/Service, Dental Insurance, Documentation, Government Organizations, Healthcare, Healthcare Quality, Leadership, Maintain Compliance, Managed Care, Nonprofit, Onboarding, Operational Audit, Operational Communications, Operational Support, Operations Management, Operations Processes, Patient Care, Patient Care Authorizations, People Management, Performance Management, Problem Solving Skills, Quality Assurance, Quality Management, Registered Nurse (RN), Regulations, Regulatory Compliance, Remote Team Management, Staff Development, Team Lead/Manager, Utilization Management, Vision Plan, Work From Home
Why Comagine Health
Comagine Health is a national, mission-driven nonprofit healthcare consulting organization dedicated to improving health and healthcare quality across the United States. For more than 50 years, we have partnered with providers, payers, communities, and government organizations to improve patient outcomes and strengthen healthcare systems.
Our talented remote workforce spans the country, and we actively support flexible remote work while fostering collaboration, innovation, and professional growth. We are committed to creating meaningful work that improves lives.
Benefits
We believe in an environment that allows you to thrive personally and professionally. Benefits include:
- Medical, dental, and vision insurance
- Paid time off for vacation, illness, and volunteering
- Retirement savings plan with employer contribution
- Adoption financial assistance
- Paid parental leave
- Annual remote work stipend
- And much more!
Position Summary
The Clinical Review Supervisor provides operational supervision of clinical staff conducting utilization review and specialty review activities. This role is responsible for guiding, training, and supporting clinical reviewers to ensure accurate determinations regarding medical necessity, quality, and appropriateness of healthcare services.
The supervisor also supports operational excellence through quality oversight, staff development, regulatory compliance, and collaboration with internal and external stakeholders.
While this is a fully remote position within the United States, the work hours are going to be based on the Pacific Standard Time zone.
Key Responsibilities
- Conduct prospective, concurrent, retrospective, and pre-authorization utilization reviews using InterQual, an evidence-based clinical criterial tool, organizational policies, and regulatory guidelines
- Supervise utilization management, care coordination, and/or case management activities to ensure quality, compliance, timeliness, and contractual performance standards are met
- Serve as an escalation point for complex clinical or operational concerns and communicate significant issues to leadership appropriately
- Support quality management initiatives, audits, training efforts, and continuous improvement activities
- Conduct onboarding, coaching, performance management, and ongoing staff development activities
- Review and approve timecards and operational documentation as needed
- Collaborate with leadership and clients regarding contractual requirements, operational processes, and reporting activities
- Maintain a strong customer service focus while supporting organizational goals and accreditation standards
Qualifications
Required
- Associate degree (AA/AS)
- Current, active, unrestricted RN license
- 5 years of direct patient care clinical experience
- 1 year of utilization review or medical management experience
- Strong communication, problem-solving, organizational, and customer service skills
- Ability to lead teams in a remote work environment
Preferred
- Bachelor’s degree (BA/BS)
- Prior supervisory or team leadership experience
- Experience working within managed care, healthcare consulting, or payer environments
- InterQual experience
Equal Opportunity Employer
Comagine Health is an equal opportunity employer and is committed to creating a diverse, equitable, and inclusive workplace.
Apply Here: https://www.click2apply.net/PjrNE8hANa1Q2Cnpptee5a
PI284922444