Nurse Team Lead - Clin Rev
Core
Lead a team of Clinical Review Nurses in balancing case review production with team management duties, ensuring regulatory compliance and service level agreements are met.
Role type
Senior IC Nurse Team Lead (Utilization Management)
Builds
Clinical review determinations for health benefit programs
Domain
Health insurance / Utilization Management
Required skills
Utilization Management, case review, team leadership, regulatory compliance (HIPAA, URAC, NCQA), conflict resolution, process improvement, data entry, critical thinking
Preferred skills
Quality Management, acute care, managed care setting experience
Technologies
Nursing assignment tools, AVAYA, ADP Workforce Now, Microsoft Office (Outlook, PowerPoint, Excel, Word, Visio)
Responsibilities
Balance case review production and team lead duties, monitor staff work assignments and adjust nurse assignment tool, ensure case-specific turnaround time and regulatory compliance, conduct selected reviews/auditing of cases to identify training opportunities, provide secondary Nursing Management coverage, handle escalated inbound calls from providers, evaluate and report HIPAA breaches, collaborate with HR and Quality Department.
Seniority
Senior, hands-on IC