Who is the Comagine Health?

Comagine Health is a national, nonprofit, health care consulting firm. We work collaboratively with patients, providers, payers, and other stakeholders to reimagine, redesign and implement sustainable improvements in the health care system.

As a trusted, neutral party, we work in our communities to address key, complex health, and health care delivery problems. In all our engagements and initiatives, we draw upon our expertise in quality improvement, care management, health information technology, analytics, and research.

We invite our partners and communities to work with us to improve health and redesign the health care delivery system.

Purpose:

Provides operational supervision of clinical staff who conduct utilization review and/or specialty reviews.

The Clinical supervisor will guide, train clinical reviewers (nurses and dental hygienists) to identify medical necessity appropriateness.

Required:

Current, active, unrestricted clinical licensures as required by the state contract.

RN

5 years of clinical (direct patient care) experience preferred.

2 or more years of supervisory or lead experience preferred.

Job Duties

Ensures the integrity and high quality of utilization management services.

Assist with developing and updating Organizational/ contractual policies and review process.

Ensure that Clinical staff meets all required legal, contractual, and accreditation standards and compliance with corporate policies.

Accepts utilization management assignments when work volumes or case complexities require supervisory intervention and support.

Provide subject matter expertise on contractual provisions and relevant regulations in conjunction with the manager.

Coordinate the team’s workflow and operations to ensure timeliness and deliverables.

Conduct informal audits quarterly and ad hoc to ensure quality as well as adherence to criteria or guidelines.

Perform 1:1 training, group training based on staff performance to measure progress and training effectiveness.

Assists with report preparation and internal quality control review.

Administer new hire onboarding activities and training.

Refer cases to other professionals internally, including behavioral health team and medical consultation, and other appropriate external sources, when indicated.

Participate in candidate interviews.

Assist with fair hearing process.

Promote, monitor, and improve positive customer service behaviors, communications, and attitudes by all staff in the provision of services to all stakeholders.

Ensures that Manager or designee is informed in a timely manner regarding significant operational issues, performance measures, complaints/grievances, compliments, quality management initiatives, staffing concerns, and other relevant topics.

Collaborate with Medical Affairs for complex case review and clinical topics.