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