Job Description

Responsibilities

  • Lead and manage a team of USRNs involved in clinical functions such as utilization management, case management, prior authorizations, appeals, or claims review.
  • Track and evaluate team performance against established KPIs and SLAs, ensuring quality, productivity, and timely delivery.
  • Ensure full compliance with HIPAA, client-specific policies, and clinical standards.
  • Conduct audits and reviews of clinical decisions to maintain accuracy and adherence to protocols.

Qualifications

  • Must hold an active USRN license (from any U.S. state)
  • Minimum of 1 year experience in an ER and/or ICU setting
  • Previous leadership or supervisory experience in either a clinical or BPO environment

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