Tech Stack

Description

You'll oversee daily operations of a clinical team, manage queue throughput and staffing, serve as an escalation point, and support strategic clinical initiatives. You'll also conduct medical necessity reviews and ensure compliance with regulatory standards.

Requirements

• Active unrestricted RN license in state of hire or compact multistate
• Associate's or Bachelor's of Nursing from accredited school
• 5+ years healthcare experience including 2+ years clinical practice in acute care
• 3+ years utilization review experience at managed care plan or provider organization
• 1+ years direct-report leadership of clinical team including virtual environment

Responsibilities

• Manage daily workforce including staffing, queue assignments, PTO, and payroll
• Ensure queue compliance with regulatory timelines and staff coverage
• Drive clinical auditing and performance evaluations using Oscar tools
• Support onboarding and training of new clinicians
• Conduct medical necessity and level of care reviews