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 client 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
Deliverable
production ML models | product features | dashboards & analysis | client delivery
Required skills
Utilization Management, nursing licensure (RN/LVN), team leadership, HIPAA compliance, regulatory standards (URAC/NCQA), case auditing, staff coaching
Preferred skills
Quality Management, acute care, managed care setting experience
Technologies
AVAYA, ADP Workforce Now, Microsoft Office (Outlook, Excel, Word, Visio)
Responsibilities
Monitor staff work assignments and adjust nurse assignment tools based on staffing levels; Conduct case reviews and audits to identify training opportunities; Evaluate team performance and report areas of opportunity; Coordinate daily physician reviewer case notifications; Handle escalated inbound calls from providers; Develop and implement team rewards and motivation strategies.
Seniority
Senior, hands-on IC