What are the responsibilities and job description for the Supervisor, Clinical Review D.C. position at Comagine Health?
Who is the Comagine Health?
Comagine Health is a non-profit consulting firm that seeks to improve health and to increase the effectiveness and quality of health care. As a recognized Quality Improvement Organization (QIO), we support providers, plans, purchasers, and consumers, and offer services to state and federal agencies and others to help them better manage health care under the existing system and to assess, plan for and implement broader system transformation. We collaborate with academic, government, and nonprofit partners on initiatives funded by NIH, CDC, AHRQ, BJA, SAMHSA, and others. In short, we are changing healthcare at a fundamental level.
While this position can reside outside of D.C., Maryland, Virginia (DMV) preferences will be with candidates within the DMV.
Purpose:
Supervisor Clinical Review
* Provides operational supervision of clinical staff who conduct utilization review and/or specialty reviews.
* The Clinical supervisor will guide, train clinical reviewers (nurses and dental hygienists) to identify medical necessity appropriateness.
Job Responsibilities:
* Conducts a variety of personnel management activities, including but not limited to recruitment, selection, on-boarding, training, evaluation, and separation, according to Comagine Health policy and practice and in collaboration with leadership and Human Resources.
* Delivers, or ensures delivery, of initial orientation and training (including review of direct reports' job descriptions), plus on-going training.
* Ensures availability of procedures, technology, and other resources necessary to conduct work activities; provides subject matter expertise as applicable.
* Provides timely, continuous recognition and feedback using objective, job-related data, and observations (including documented performance appraisals); timely initiates performance improvement opportunities in alignment with Comagine Health policy and practice.
* Develops and monitors professional development goals and objectives; assigns work and delegates authority appropriate for established, job-related duties, responsibilities, and qualifications.
* Assist with developing and updating Organizational/ contractual policies and review process.
* Ensure that Clinical staff meets all required legal, contractual, and accreditation standards and compliance with corporate policies.
* Accepts utilization management assignments when work volumes or case complexities require supervisory intervention and support.
* Provide subject matter expertise on contractual provisions and relevant regulations in conjunction with the manager.
* Coordinate the team's workflow and operations to ensure timeliness and deliverables.
* Conducts informal audits quarterly and ad hoc to ensure adherence to criteria.
* Perform 1:1 training, group training based on staff performance to measure progress and training effectiveness.
* Assists with report preparation and internal quality control review.
* Administer new hire onboarding activities and training.
* Refer cases to other professionals internally, including behavioral health team and medical consultation, and other appropriate external sources, when indicated.
* Participate in candidate interviews.
* Assist with fair hearing process.
* Promote, monitor, and improve positive customer service behaviors, communications, and attitudes by all staff in the provision of services to all stakeholders.
* Ensures that Manager or designee is informed in a timely manner regarding significant operational issues, performance measures, complaints/grievances, compliments, quality management initiatives, staffing concerns, and other relevant topics.
* Collaborate with Medical Affairs for complex case review and clinical topics.
Requirements:
* 5 years of clinical (direct patient care) experience preferred.
* 3 years of medical management experience.
* 3 years of customer service or other relevant work experience.
* 1 year of supervisory or lead experience Preferred.
Education:
* BA/BS in a related field
* Equivalent combination of education and/or work experience in related field may be substituted.
Licensure:
Required:
* Current, active, unrestricted District of Columbia registered nurse licensure.
Compensation Range:
$84,000 - $120,000
Geographical location considered in compensation range.
Equal Employment Opportunity Employment Comagine Health is an Equal Employment Opportunity/Affirmative Action Employer that embraces and practices diversity, reflecting the communities we serve. We encourage minorities, protected veterans and individuals with disabilities to apply.
Salary : $84,000 - $120,000
