Clinical, Supervisor - RN Remote U.S. Alaska Time Zone

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.

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. *

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.
• 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 Inter Qual 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.

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 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.

EEO AA M/F/Vet/Disability

Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive…