In the Clinical Supervisor (RN) role, you will complete the full spectrum of activities related to Federal Independent Dispute Review Organization (IDR) case determinations. The Clinical Supervisor (RN) will conduct clinical level review, determine physician level assignment, manage case staging between external physician experts and manage appeal processes within strict deadlines. This individual will direct the workflow of the clinical reviewer's assigned to them, monitor quality control and direct team goals through effective employee training in the final payment determination rationales, and a thorough understanding of single, bundled, and batched cases. The Clinical Supervisor (RN) must be a resourceful team player with a positive attitude and eagerness to ensure customer satisfaction in the Federal IDR Process and for other State and Federal entities. Duties to include but not limited to:

• Conduct reviews which include chart screening, writing case summaries, determining documentation adequacy, researching insurer requirements, complete decision templates and preparing final determinations.
• Training and mentoring new RNs as the project expands.
• Understanding multi-state requirements.
• Responsible for the day-to-day management of the clinical reviewer's teams assigned to them.
• Responsible for supervisory functions such as employee timelines, employee productivity and reporting measures, reviewing timesheets for final approval, approving time off request, new employee checklist.
• Direct employees and subcontracted staff in meeting quality and on-time delivery requirements.
• Managing workflow and ensuring that employees understand their responsibilities and delegated tasks.
• Set performance goals and deadlines in alignment with the company vision and report variances to senior managers.
• Communicate directly with the customer to troubleshoot concerns, present case scenarios, and communicate new directives and solutions.

This position is office based at our Jericho, NY office.

QUALIFICATIONS:

• Knowledge and experience with electronic medical records.
• Ability to oversee, problem solve, and work collaboratively with peers, medical, analytical, and administrative support staff.
• Excellent written and verbal skills.
• Ability to work independently with little supervision.
• Ability and desire to be flexible, innovative, and creative.
• Ability to meet deadlines in a time sensitive environment.

EDUCATION AND EXPERIENCE:

• Licensed, Registered Nurse, required.
• Baccalaureate degree in Nursing OR graduate of an approved Registered Professional Nurses training program, required.
• Two (2) years' experience in a clinical setting required.
• One (1) year experience working in Independent Dispute Resolution, required.

The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. The annualized salary range for this position is $92,000.00 - $100,000.00. Actual salary range and /or hourly rate depends on a variety of factors including experience, education, credentials, location, and budget.

The salary range and/or hourly rate listed does not include other forms of compensation or benefits.