Clinical Nurse Supervisor, Prior Authorization
Join Regal Medical Group as a Prior Authorization Clinical Nurse Supervisor. This role supports outpatient services by overseeing Prior Authorization Lead Nurses and Review Nurses and ensuring compliance with medical management referral processing guidelines.
Base Pay Range
$100,000.00 – $105,000.00 per year (dependent on experience, location and market factors)
Essential Duties and Responsibilities
Supervise and support pre‑authorization staff to meet patient service standards.
Utilize Access Express/Heritage Connect for prior authorization and customer service modules.
Promote and enforce Utilization Management (UM) principles to deliver timely, appropriate care.
Complete assigned tasks accurately and within designated timelines.
Plan workflow, set realistic goals, and coordinate activities for efficient time management.
Apply Regal Medical Management policies to create and maintain consistent job aids.
Communicate effectively with managers, compliance officers, medical directors, and staff regarding medical management processes.
Identify training needs, coordinate training sessions, and troubleshoot audit deficiencies.
Maintain patient confidentiality and HIPAA compliance.
Present information clearly to diverse audiences, demonstrating professionalism and respect.
Maintain punctuality and flexibility regarding breaks and scheduling.
Respond proactively to provider needs and follow up on requests promptly.
Demonstrate honesty, integrity, and accountability in all responsibilities.
Report errors promptly and collaborate with management and colleagues.
Work inter‑departmentally to ensure seamless patient care.
Monitor quality indicators and report findings to management.
Execute additional duties as directed by management.
Manage resources efficiently and responsibly.
Build positive working relationships, demonstrating strong teamwork.
Identify UM process trends, report concerns to the UM Manager, and communicate updates to UM staff.
Maintain organized UM logs and process approveable requests efficiently.
Summarize audit data into quarterly progress reports.
Review staff timesheets, validate PTO requests to prevent scheduling conflicts.
Education and Experience
Graduate of an accredited Vocational Nursing Program.
California LVN License in good standing.
Knowledge of Healthcare and Managed Care.
Typing speed: 60 words per minute with accuracy.
Proficient with computers, faxes, printers, and related equipment.
Proficient in MS Office (Word, Excel, Outlook, Access, PowerPoint).
Capability to handle confidential matters responsibly.
Ability to work in a multi‑task, high‑stress environment.
Prioritization and deadline‑management skills.
Benefits
Regal Medical Group offers a comprehensive benefits package, including medical, dental, vision, and retirement plans. Employees receive:
Employer‑paid medical, pharmacy, and dental coverage.
Vision insurance with zero copay for office visits.
Flexible Spending Account (FSA).
Employer‑paid life insurance.
Employee Assistance Program (EAP) and behavioral health services.
401(k) retirement savings plan.
Paid time off: vacation, sick leave, and holidays.
Tuition reimbursement and CEU cost reimbursement for license renewal.
Equal Opportunity Employment
The company will consider qualified applicants with criminal histories in a manner consistent with the LA City Fair Chance Initiative for Hiring Ordinance.