Overview

This position supervises a team of USRNs to deliver accurate, high-quality clinical support and services for healthcare clients within a BPO setting. The role includes managing team performance, providing training and coaching, and ensuring compliance with HIPAA, client policies, and SLA standards.

Responsibilities

• Overseeing clinical processes such as utilization management, prior authorizations, appeals, and claims review.
• Monitoring KPIs related to quality, productivity, and turnaround times.
• Reviewing clinical decisions for accuracy and protocol adherence.
• Ensuring effective team performance and compliance with regulatory and client requirements.

Qualifications

• Active USRN license from any state
• At least one (1) year of experience in ER and/or ICU
• Leadership/supervisory background gained either in a clinical or BPO setting