Clinical, Supervisor

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.

At Acentra Health, we embrace emerging technologies, including artificial intelligence and advanced analytics that can be utilized to improve processes, enhance decision-making, and drive better health outcomes. We value professionals who are curious about new technologies and motivated to use innovative tools to increase efficiency, quality, and impact in their roles.

Acentra Health is looking for a Clinical, Supervisor to join our growing team.

Job Summary:

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• The Clinical Supervisor – Registered Nurse – Full-time (Remote U.S.), provides clinical and operational leadership for prior authorization, utilization management, and Home- and Community-Based Services waiver plan review activities. This role oversees clinical review functions for Indiana Medicaid programs, including current and future waiver programs assigned to the organization.
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  With a strong clinical foundation and leadership acumen, the Clinical Supervisor ensures that processes are executed efficiently, consistently, and in alignment with regulatory and contractual standards. A key focus of the role is to uphold excellence in clinical programs, fostering continuous improvement and innovation in care management practices. Additionally, the Clinical Supervisor is instrumental in cultivating and maintaining strong relationships with customers and stakeholders, ensuring that service delivery meets or exceeds expectations and contractual obligations. The Clinical Supervisor will have oversight of direct reports.

Responsibilities:

• • Lead and oversee waiver service-plan review activities and utilization management (as needed).
  • Review service plans and related documentation to determine whether requested services are supported by the member’s assessed needs, functional limitations, health and safety risks, person-centered goals, and available clinical information.
  • Prepare or oversee clinically sound recommendations to approve, modify, reduce, or not approve services in accordance with policy and contractual requirements.
  • Identify trends involving unnecessary services, duplication, incomplete documentation, inappropriate utilization, or opportunities for provider and case-management education.
  • Monitor daily work queues and adjust staffing schedules to align with departmental demands.
  • Evaluate productivity and performance metrics of reviewers to maintain high standards of efficiency and quality.
  • Identify onboarding and ongoing learning needs for staff; collaborate with leadership to design and implement effective development plans.
  • Actively participate in leadership meetings, committees, and cross-functional workgroups to promote shared decision-making and continuous improvement.
  • Work with senior leadership to Identify areas for process and clinical improvements; develop and execute action plans to enhance outcomes.
  • Serve as a liaison to customers and providers, ensuring timely resolution of issues and promoting service excellence.
  • Stay current with clinical best practices, UM protocols, and Medicaid policy and act as the primary resource for the review staff.
  • Support departmental and organizational goals by performing additional duties as assigned.
  • Read, understand, and adhere to all corporate policies, including policies related to HIPAA and its Privacy and Security Rules.

   

The list of accountabilities 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.

Required Qualifications

• • An active, unrestricted Indiana license or valid compact license as a Registered Nurse
  • 5+ years of clinical nursing experience.
  • 3+ years of supervising and performance managing staff in a healthcare setting
  • At least two years of experience in utilization management, clinical case management, HCBS waiver services, behavioral health, intellectual/developmental disabilities, brain injury, or a related clinical review environment.
  • Demonstrated experience interpreting clinical documentation, assessing functional needs, applying medical-necessity or service-authorization criteria, and making defensible clinical recommendations.
  • Working knowledge of person-centered service planning, HCBS waiver services, service-plan development, and coordination of services across funding sources.

Preferred Qualifications

• • Bachelor’s degree.
  • Experience with Indiana Medicaid or Indiana HCBS waiver programs.
  • Experience working with individuals with intellectual or developmental disabilities, acquired or traumatic brain injury, complex medical conditions, behavioral health needs, or significant functional limitations.
  • Experience using InterQual, waiver-specific criteria, functional assessments, or comparable clinical review tools.
  • Strong verbal and written communication skills, with the ability to convey complex information clearly and professionally and utilize critical thinking skills.
  • Demonstrated customer-centric approach with a focus on achieving results and fostering positive relationships with internal and external stakeholders.
  • Excellent organizational and time management skills, with the ability to prioritize multiple tasks effectively.
  • Proven ability to work both independently and collaboratively within a team environment.
  • Proficiency in Microsoft Office Suite and other relevant software applications is essential to the role.
  • Ability to provide technical guidance and leadership support to management and clinical teams.
  • Perform other related duties as assigned.

Why us?

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

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.

Thank You!

We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search!

We are committed to providing a secure and positive hiring experience. Depending on the role, interviews may be conducted virtually, in person, or through a combination of both. As part of our recruitment process, candidates may be asked to participate in identity verification measures to help ensure the integrity of the hiring process.

~ The Acentra Health Talent Acquisition Team

Visit us at https://careers.acentra.com/us/jobs

EEO AA M/F/Vet/Disability

Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.

Experience in Lieu of Degree

For non-clinical roles, or when not required by the contract specifically, the Company acknowledges that practical, hands-on experience can provide skills and competencies equivalent to formal education. As such, in cases where a Bachelor’s degree may be required, the Company will accept a minimum of six (6) years of directly relevant professional experience in lieu of a degree. In instances where the candidate has an Associate’s degree, the Company will accept a minimum of three (3) years of directly relevant professional experience in lieu of the Bachelor’s degree.

Compensation

The pay for this position is listed below.

“Based on our compensation philosophy, an applicant’s position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level.”