Utilization Management, Clinical QA Supervisor
Remote · West Palm Beach, Florida, United States
Job Summary
Oversee the review of physician reports and accompanying medical records to ensure completeness, accuracy, and alignment with medical evidence. Supervise QA staff, assign file handling responsibilities, manage the File Review Board for timely, accurate processing, and report board results to managers. Participate in staff performance management (promotions, discipline, coaching, termination) and assist in hiring qualified QA candidates. Ensure referrals meet client Turn Around Time (TAT), follow up with physicians for outstanding reports, review received reports for accuracy, deliver completed reports, and adhere to client-specific instructions. Serve as liaison among reviewers, team members, and clients, and participate in issue resolution with QA staff, physicians, account managers, and related parties. Other duties and special projects as needed.
Required Qualifications
- RN licensure required
- An Associate’s Degree or Bachelor’s Degree preferred
- Medical peer review or healthcare industry knowledge required
Desired Qualifications
- RN licensure required
- An Associate’s Degree or Bachelor’s Degree is preferred
- Medical peer review or healthcare industry knowledge required
- Business experience in a healthcare and/or insurance setting is preferred
- Present exceptional communication skills with a clear understanding of company business lines
- The ability to apply critical thinking, manage time efficiently and meet specific deadlines
- Computer literacy and typing skills are essential
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