Supervisor, Medical Frailty Review Nurse

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🔥 1 minute ago

🌴 South Carolina, Tennessee, +1 more states – Remote

🌴 South Carolina – Remote 🎸 Tennessee – Remote 🍑 Georgia – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 12%

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Alliant Health Solutions

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1970

🏥 Healthcare

🏛️ Government

🤝 Non-profit

Healthcare • Government • Non-profit

Alliant Health Solutions is a nonprofit organization that works with government agencies, health systems, commercial insurers and patients to improve the quality, safety and efficiency of health care. Clinically led, Alliant provides care management and utilization management (medical review, prior authorization, case management, level-of-care determination), program integrity services to reduce fraud/waste/abuse, quality improvement using data-driven evidence-based methods, and education and training for providers and consumers. The organization operates ESRD network contracts and other government-focused health programs, emphasizing data-driven insights and agile processes to improve outcomes and compliance.

📋 Description

• Supervise daily Medical Frailty nursing review activities • Assign and balance review workloads based on referral volume, case complexity, nurse availability, and priorities • Coordinate coverage to maintain continuity of review operations • Provide clinical and operational guidance on criteria, procedures, documentation standards, and escalation protocols • Provide onboarding, training, coaching, and day-to-day guidance to review nurses • Monitor pending reviews, case aging, and turnaround times • Conduct quality checks for completeness, accuracy, consistent criteria application, and clinical support • Address quality gaps and coordinate corrective follow-up • Promote consistency through case discussions, review calibration, and criteria clarification • Ensure reviews and determinations are completed only by personnel with required licensure and delegated authority • Coordinate with case-management staff regarding incomplete, unmatched, duplicate, or problematic records • Identify supplemental medical documentation and coordinate approved outreach requests • Ensure clinical findings, supporting documentation, review outcomes, and case status are accurately recorded • Review complex or escalated cases within authorized scope and coordinate consultation or referral • Communicate review status, information needs, and operational barriers to the Program Manager and internal team members • Identify trends and recommend workflow improvements • Ensure compliance with Medical Frailty workflows, approved criteria, job aids, policies, confidentiality requirements, and DCH-approved communications • Collaborate on new projects and continuous improvement • Maintain security and confidentiality in accordance with HIPAA and company policies • Perform other duties as assigned

🎯 Requirements

• Current, active, unrestricted Registered Nurse (RN) license valid for the jurisdiction in which assigned nursing review duties are performed • Clinical nursing experience • Experience reviewing medical records, applying clinical criteria, and documenting clinical findings • Experience providing team leadership, staff training, and/or clinical guidance in a healthcare setting • Ability to supervise and lead a team • Knowledge of nursing assessment, medical terminology, clinical documentation, and medical records • Ability to interpret and consistently apply approved Medical Frailty criteria, policies, and review procedures within nursing scope and delegated authority • Knowledge of protected health information safeguards, confidentiality requirements, and secure handling of clinical records • Ability to explain clinical-review requirements and findings clearly • Ability to manage time, organize and prioritize complex work and competing priorities • Ability to clinically assess and reason with attention to detail • Ability to document objective findings supported by the medical record and recognize missing, conflicting, or insufficient clinical information • Ability to follow consultation and escalation protocols • Proficiency with electronic clinical-review systems, medical records, standard office software, and other applications • Ability to work independently and remotely • Ability to travel by car or plane to Company locations, customer meetings, or other locations as needed • Preferred: Bachelor of Science in Nursing (BSN) • Preferred: Experience supervising a nursing review, utilization management, medical review, or related clinical team • Preferred: Experience with Medicaid, Medical Frailty reviews, health-plan operations, or government healthcare programs • Preferred: Experience conducting clinical-review quality checks, review calibration, and workflow improvement • Preferred: Healthcare, government, and/or nonprofit experience • Ability to maintain HIPAA confidentiality and comply with company policies • Ability to work during core office business operational hours as required • Ability to regularly remain in a stationary position and occasionally move about the office • Ability to occasionally move or transport materials weighing up to 30 pounds

🏖️ Benefits

• 2026 Best Place to Work and Healthiest Employer designation • Remote work capability • Travel to Company locations, customer meetings, or other locations as needed • Professional development through onboarding, ongoing training, coaching, and day-to-day guidance • Team leadership and clinical guidance opportunities • Collaboration on new projects and continuous improvement initiatives

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