Supervisor, Clinical Review

About Company:Why Comagine Health?Comagine Health is a national, mission-driven, nonprofit organization that has engaged in health care quality consulting and quality improvement services for more than 50 years.We are leaders in assisting front-line providers and engaging health care partners to improve care delivery and patient outcomes.Our talented remote workforce spans the country and plays a vital role in our success. We go beyond merely providing a remote work option; we support and embrace it. We offer opportunities to make a difference from anywhere in the U.S. and enjoy better work-life balance. An annual stipend gives you the freedom to enhance your workspace with options that suit your needs.We believe in an environment that allows you to thrive both personally and professionally. That's why we offer benefits that include:Medical, dental and vision insurancePaid time off for vacation, illness and volunteeringRetirement savings plan with employer contributionAdoption financial assistancePaid parental leaveAnd much moreComagine Health actively cultivates an organizational culture that fosters well-being and prioritizes engagement, connectedness and collaboration among team members.Each employee's unique background, perspective and abilities are fundamental to the success of our mission and agine Health is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability. We are proud to be a Recovery Friendly Workplace, supporting the health and well-being of all employees.About the Role:This role requires that the employee is an active RN.The Supervisor, Clinical Review plays a critical role in providing operational supervision of clinical staff who conduct utilization review and/or specialty reviews.The Clinical Review supervisor will guide and monitor, and train clinical reviewers to identify medical necessity/medical appropriateness as identified by identified criteria, specific contract guidelines, and/or organizational clinical criteria.Minimum Qualifications:Minimum of 3 years of clinical experience in a healthcare setting.Active RN licensure.At least 1 year of supervisory or team leadership experience in a clinical environment.1 year of medical management / utilization review experience3 years of customer service or other relevant work experienceStrong knowledge of clinical review processes, healthcare regulations, and medical terminology.Proficiency with electronic medical records (EMR) systems and clinical documentation standards.Preferred Qualifications:LCSW, LPC licensure or equivalent clinical certification.3 years of medical management / utilization review experienceExperience with health plan operations or managed care organizations.Familiarity with state and federal healthcare regulations, including HIPAA and CMS guidelines.5 years of clinical (direct patient care) experienceResponsibilities:The supervisor, will display, critical thinking abilities, strong leadership skills, wise decision-making abilities, organized, knowledgeable and excellent terQual criteria experience preferredDemonstrated leadership ability within a team, including management of personnel, meeting targets, and facilitating process improvement petent in understanding medical/clinical terminology, diagnoses, and documentationSkills:The required skills enable the supervisor to effectively lead clinical review teams by applying clinical knowledge to evaluate patient care documentation and ensure compliance with healthcare standards. Strong com

Created: 2025-12-08