RN Clinical Review Lead - Compliance & Care Oversight (AL)

About Company 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 insurance Paid time off for vacation, illness and volunteering Retirement savings plan with employer contribution Adoption financial assistance Paid parental leave And much more! Comagine 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 organization. Comagine 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 and based in Alabama. 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 All nurse reviewers will be located and licensed within Alabama and in good standing with the Alabama Board of Nursing and Board of Medical Examiners. Experience with: Performing PA reviews Long-term care including nursing home, ICF/IID, swing bed, PEC, and inpatient psychiatric facilities Minimum of 3 years of clinical experience in a healthcare setting. At least 1 year of supervisory or team leadership experience in a clinical environment. 1 year of medical management / utilization review experience Strong 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 experience Experience 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) experience Responsibilities The supervisor, will display, critical thinking abilities, strong leadership skills, wise decision-making abilities, organized, knowledgeable and excellent communicator. Demonstrated leadership ability within a team, including management of personnel, meeting targets, and facilitating process improvement efforts. Competent in understanding medical/clinical terminology, diagnoses, and documentation Skills 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 communication and interpersonal skills are essential for collaborating with multidisciplinary teams and resolving clinical issues efficiently. Analytical skills are used daily to interpret clinical data, identify trends, and implement quality improvement initiatives. Proficiency with EMR systems and clinical software supports accurate documentation review and reporting. Preferred skills such as advanced certifications and familiarity with regulatory frameworks enhance the supervisor's ability to navigate complex healthcare environments and drive continuous improvement in clinical review processes. #J-18808-Ljbffr Council of State and Territorial Epidemiologists