Supervisor, Clinical Review Nurse
TurningPoint Healthcare Solutions
Remote
Nurse Reviewer
Job Description
TurningPoint is an innovative healthcare services and technology organization that is committed to working with Health Plans and Providers to develop advanced technical and clinical solutions that improve the quality and affordability of surgical care patients receive. We are seeking a highly motivated and results orientated Nurse Supervisor to join our fast-paced and rapidly growing company.
Primary Responsibilities
This position is responsible for Utilization Management (UM) activities, including but not limited to the supervision of UM and Prior Authorization clinical team processes. This individual develops, implements, supports and promotes managed care strategies, policies and programs that drive the delivery of quality healthcare.
- Providing leadership and demonstrating responsibility and accountability for the delivery of quality services to a team of clinical staff
- Reviewing pre-authorization requests for appropriateness of care within established evidence-based criteria sets
- Interacting with other TurningPoint personnel to assure quality customer service is provided.
- Acting as an internal resource by answering questions requiring clinical interpretation
- Identifying high cost utilization and making appropriate referral
- Assisting the Director of Utilization Management in developing guidelines and procedures for the department
Skills, Education & Experience Requirements
- An active and unrestricted Registered Nurse (RN)
- Associate’s Degree is required. Bachelor of Science in Nursing (BSN) Degree is preferred
- Five (5) years of clinical experience; or any combination of education and experience, which would provide an equivalent background
- Experience in surgical utilization review, pain management, case management, or health insurance pre-authorization and/or utilization management
- Minimum of 3 years experience Supervising and Managing a team of clinical and non-clinical staff members
- Ability to function effectively in an interdisciplinary team that includes physicians, nurses, other healthcare personnel and administrative staff
- Ability to work independently with minimal supervision
- Ability to organize, prioritize and complete work in a timely manner despite many deadlines and competing priorities
Benefits
TurningPoint offers a number of benefits to full-time employees including, but not limited to: medical, dental, vision, disability, life, PTO. All employees, age 21 and over, are eligible to participate in the 401(k)-retirement savings plan.
Job Type: Full-time
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