Clinical, Supervisor - RN - Full-time (Remote U.S. within Alaska Time Zone Hours)

Company Overview

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

 

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes – making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

Job Summary and Responsibilities

Acentra Health is looking for a Clinical, Supervisor - RN - Full-time (Remote within Alaska Time Zone Hours) to join our growing team.

 

Job Summary:

• The Clinical Supervisor (RN) role will oversee and manage the Utilization Management activities. The primary focus is to maintain high standards in clinical programs and enhance customer relationships to ensure contract requirements are met successfully.

Responsibilities:

• Manage and oversee Utilization Management (UM) activities.
• Ensure overall consistency, thoroughness, and accuracy of clinical programs.
• Oversee program to ensure clinical efficiencies, deliverables, and contract functions meet high standards.
• Strengthen relationships with customers and meet contract requirements.
• Provide day-to-day oversight to manage the utilization review program.
• Responsible for utilization reviews as defined by the contract to include prior authorization and retro reviews.
• Serve as a Subject Matter Expert (SME) and works with other Service Authorization (SA) nurses to ensure the appropriate, effective, and cost-efficient use of healthcare services for Medicaid beneficiaries.
• Evaluates SA requests for medical services to ensure they meet the criteria for medical necessity.
• Participate as a team member fostering collaborative decision-making among leadership, committees, teams, or work groups of diverse composition.
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.

The above list of responsibilities is not intended to be all-inclusive and may be expanded to include other education- and experience-related duties that management may deem necessary from time to time.

 

PLEASE NOTE:

 

* This role is contingent upon being awarded a contract. Start dates and final offers are contingent upon the contract award and final contract start dates. * 

Qualifications

Required Qualifications/Experience:

• Must be available to work business hours as defined by contract within the Alaska Time Zone.
• An active, unrestricted Licensed Registered Nurse (RN) in the State of Alaska.
  • OR the ability to obtain Alaska RN state licensing within three months of your start date, if selected.
• Associate degree or equivalent directly applicable experience in nursing, healthcare administration or a related area.
• 5+ years of experience in Utilization Management (UM), Service Authorization (SA), or other clinical review process for Medicaid or another large healthcare payer.

Preferred Qualifications/Experience:

• Residency within Alaska, Pacific, OR Mountain Time Zone.
• Bachelor of Science in Nursing (BSN).
• Excellent verbal and written communication skills.
• Current working knowledge of utilization management.
• Customer-focused, results-oriented, and capable of building and maintaining relationships with internal and external customers.
• Organizational skills, ability to plan and prioritize multiple assignments.
• Current InterQual and Milliman criteria knowledge.
• Experience in using systems that support Utilization Review processing.
• Ability to work in team setting and independently.
• Computer proficiency in Microsoft Office applications and other software programs essential to perform job functions.
• Ability to provide technical guidance and leadership to management team.

#LI-SD1

 

Why us?

 

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

 

We do this through our people.

 

You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

 

Benefits

 

Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

 

Thank You!

 

We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search!

 

~ The Acentra Health Talent Acquisition Team

 

Visit us at Acentra Health 

 

EEO AA M/F/Vet/Disability

 

Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.

 

Compensation

 

The pay for this position is listed below.

 

"Based on our compensation philosophy, an applicant’s position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level."

Pay Range

USD $84,080.00 - USD $105,110.00 /Yr.