In this remote RN leadership role, the clinician oversees a team of RN reviewers handling utilization management and prior authorization work. Day to day, the focus is on coaching staff, monitoring productivity and turnaround times, and providing feedback to help the team meet performance and quality standards. The role also involves supporting process improvements, training new nurses, and partnering closely with clinical operations leadership.
Key Responsibilities
- Oversee the RN Reviewer team, including an RN Team Lead.
- Establish daily workflow priorities and communicate the plan to staff.
- Monitor timeliness reports and ensure cases meet expected turnaround times.
- Track nurse productivity and provide ongoing performance feedback.
- Lead weekly team meetings and bi-weekly one-on-ones with direct reports.
- Identify process improvement opportunities and work with stakeholders to implement changes.
- Train and develop new nurses joining the team.
- Oversee daily newsletter publication and support other projects as needed.
Required
- Active, unencumbered Registered Nurse license.
- 2-3 years of supervisory or management experience.
- Experience with prior authorization or utilization management.
- Knowledge of NCQA and CMS requirements.
- Experience using MCG, CMS NCDs/LCDs, and clinical criteria guidelines.
- Experience supervising and training in a remote work environment.
Preferred
- Experience working with a Mac.
- Strong computer skills.
Benefits & Perks
- Fully remote work with about 5% travel.
- Medical, dental, vision, life, and disability insurance.
- Employee Assistance Program.
- 401(k) with company match.
- Flexible spending and health savings accounts.
- Flex Time Off plus company holidays.
- Up to 14 weeks of paid parental leave.
- Pet insurance.
- Salary range of $85,000 to $95,000 annually, plus bonus.