Medical Review Supervisor
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Medical Review Supervisor overseeing clinical review teams for Palmetto GBA, a healthcare claims and transaction-processing administrator. Managing quality control, staff performance, audits, reports, and healthcare service review operations.
Responsibilities:
- Manage day-to-day activities for assigned staff
- Identify training needs and verify accuracy and timeliness of workflow functions
- Supervise staff, including approval of time, leave, and performance reviews
- Select, train, and motivate staff to provide excellent customer service
- Perform quality control functions for work performed
- Develop work plans to improve quality performance
- Prepare, review, and maintain weekly and monthly reports
- Develop, maintain, and update procedures and documentation for conducting audits
- Develop and communicate department standards and staff expectations
- Coordinate special projects and system testing enhancements
Requirements:
- Associate's degree in a job-related field
- Graduate of an Accredited School of Nursing may satisfy the degree equivalency
- 5 years of clinical or utilization review/medical review experience, including 3 clinical years
- 1 year in a team lead/leadership role or equivalent military experience in grade E4 or above; may be concurrent with the 5 years
- Working knowledge of word processing, spreadsheet, and database software
- Ability to work independently, prioritize effectively, and make sound decisions
- Working knowledge of managed care and/or various forms of health care delivery systems
- Strong clinical experience including home health, rehabilitation, and/or broad medical-surgical experience
- Knowledge of specific criteria/protocol sets and their use
- Good judgment, customer service, organizational, presentation, spelling, punctuation, and grammar skills
- Ability to persuade, negotiate, or influence others
- Analytical or critical thinking skills
- Ability to handle confidential or sensitive information with discretion
- Ability to lead, motivate, and assess performance of others
- Microsoft Office proficiency
- Active, unrestricted RN licensure from the United States and in the state of hire, or an active, compact multistate unrestricted RN license under the Nurse Licensure Compact
- Preferred: Bachelor's degree in nursing (BSN), Master's degree in nursing (MSN), or MSN in Nursing Education; additional clinical experience may be considered in lieu of preferred education
- Preferred: 3 years of utilization/medical review, quality assurance, or home health experience, plus 5 years of clinical experience
- Preferred experience with PA & RCD Programs, FISS, and MCS
- Preferred knowledge of spreadsheet and database software, Medicare regulations/policies/instructions/provisions, home health, and medical review system/processing procedures
- Preferred working knowledge of Microsoft Excel, Access, or other spreadsheet/database software
Benefits:
- Subsidized health plans
- Dental and vision coverage
- 401k retirement savings plan with company match
- Life Insurance
- Paid Time Off (PTO)
- On-site cafeterias and fitness centers in major locations
- Education Assistance
- Service Recognition
- National discounts to movies, theaters, zoos, theme parks and more
- Training classes and programs that help employees prepare for leadership positions
- Tuition assistance for education advancement
- Awards and financial incentives
Similar Jobs
Licensed Supervisor, Care Management
Licensed Supervisor overseeing integrated care-management teams for Trillium Health Resources, a North Carolina behavioral-health managed-care organization. Providing clinical guidance, compliance oversight, and complex-case coordination.
Art Supervisor
Art Supervisor leading multichannel creative and art direction for EVERSANA INTOUCH, a life sciences marketing agency. Developing compliant healthcare campaigns, data visualizations, and cohesive brand experiences.
Supervisor de Transporte
Supervisor de Transporte gestionando flota, proveedores y seguridad operativa para Repsol. Coordinando logística secundaria y operaciones en Arequipa y otras rutas.
Intake and Case Initiation Supervisor
ICF supervisor leading federally funded legal-services intake and case initiation for unaccompanied children. Managing coordinators, workflows, data quality, provider handoffs, and operational reporting nationwide.
Logistics Supervisor
Logistics Supervisor overseeing transportation, warehouse, and distribution operations for Ryder. Coordinating teams, schedules, KPIs, safety, customer service, and performance improvement.
ABA Program Supervisor
ABA Program Supervisor delivering behavior therapy for children and adolescents through California-based behavioral healthcare provider. Designing treatment plans, supervising interventionists, conducting assessments, and coaching families under BCBA guidance.
Supervisor, Care Coordination
Supervisor leading remote care coordination teams for Centene, a national healthcare organization. Ensuring compliant member services, continuity of care, team performance, and community-based support.
Revenue Cycle Management Supervisor
Revenue cycle supervisor overseeing intake, billing, collections, and reimbursement for Option Care Health’s home infusion services. Managing staff productivity, payer invoicing, follow-up, training, and process quality.
Supervisor, Payer Enrollment & Reporting
Supervisor overseeing payer enrollment, credentialing, and delegated reporting for West Virginia’s largest health system. Managing staff, provider data, regulatory compliance, and payer operations.
CAAS Supervisor – I
CAAS Accounting Supervisor overseeing financial reporting, bookkeeping, and audit preparation for US CPA-firm partners. Supervising accounting teams and managing multi-client engagements remotely from the Philippines.
Shift Lead Supervisor – WordPress Support
Shift Lead Supervisor leading global WordPress hosting support at Rocket.net. Providing advanced technical assistance, coaching Support Engineers, and overseeing infrastructure and shift operations.
Site Supervisor
Site Supervisor for Hydro Tech coordinating field operations and supporting crew management. Managing safety compliance and executing project plans on hydroelectric construction sites.
Supervisor – Power Project
Supervisor managing a team within a power project in a remote role from Sarajevo, Bosnia and Herzegovina. Focused on team performance and improvement.
Site Supervisor
Site Supervisor managing high-voltage AIS/GIS projects for GE Vernova in the UK. Overseeing installation, maintenance, and ensuring project safety and quality compliance.
Media Supervisor
Media Supervisor overseeing execution of digital media plans for higher education clients. Collaborating with strategists and ensuring high-quality execution of campaigns.
Field Supervisor – Construction
Field Supervisor responsible for planning and monitoring construction jobs in elevator industry. Ensuring safety and quality standards while leading project operations.
Customer Service Supervisor
Customer Service Supervisor leading remote support team, managing performance indicators and providing development support. Collaborating with internal teams in Belo Horizonte area.
Property Claims Supervisor – PA/OH
Property Claims Supervisor responsible for leading claims professionals in property claims at Davies North America. Ensure compliance with standards and provide operational efficiency.
Foreclosure Supervisor
Foreclosure Supervisor at Valon leads all foreclosure activities in compliance with laws and guidelines. Responsible for managing the team's efficiency and improving operational processes.
Site Supervisor Mechanical – Site Supervisor Mechanic
Site Supervisor Mechanic overseeing assembly of automated storage and distribution systems in Germany and Austria. Collaborating with teams to ensure high quality and timely installations.