Supervisor, Medical Management-RN
Core
Provide oversight and support to Medical Management clinical staff, operations, and department adherence to protocol, procedures, and regulatory compliance standards.
Role type
Senior Medical Management Supervisor (RN)
Builds
Medicare Advantage care models and fully integrated care for older adults
Domain
Healthcare / Medicare Advantage / Utilization Management
Required skills
RN license, Inpatient Utilization Management, Medicare Advantage knowledge, Clinical performance auditing, Regulatory compliance (CMS/DMHC/DHCS/NCQA), Staff coaching and performance improvement, Workflow and policy development
Preferred skills
Bachelor's Degree in Nursing, 1+ years of leadership experience, AI curiosity
Technologies
CMS, DMHC, DHCS, NCQA, Interrater Reliability testing tools
Responsibilities
Assess clinical staff performance and develop education/performance improvement plans; Conduct regular audits to ensure quality, compliance, and monitor outcomes of Interrater Reliability testing; Provide guidance on complex clinical issues and escalation needs; Support department needs around policy, procedures, workflows, and training materials; Communicate job expectations, plan, monitor, and appraise job results; Ensure productivity and quality metrics align with department goals.
Seniority
Mid-Senior, hands-on IC with leadership duties