Nursing Supervisor

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🕒 June 17

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Qlarant

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1973

🏛️ Government

⚕️ Healthcare Insurance

Government • Healthcare Insurance • Insurance & Financial Services

Qlarant is a US-based services and technology firm specializing in healthcare program integrity, offering quality improvement, fraud, waste & abuse (FWA) detection and investigative services, and advanced data analytics and predictive modeling tools (the RIViR® Risk Solution Suite) for government agencies, health plans, and related sectors. The company also operates initiatives like the Qlarant Foundation and Qlarant Capital to fund grants and early-stage startups, and provides pharmacy, drug pricing, and transportation-focused solutions.

📋 Description

• Owns responsibility for ensuring the optimal performance of the medical review division, continuously monitoring and analyzing performance metrics to identify opportunities for improving processes and procedures. • Assists and supports Director – Medical Operations in operations and administration of contracts, overseeing the day-to-day activities of clinical teams. • Supervises teams to monitor and ensure compliance with relevant laws, regulations, and organizational policies. • Collaborates inter-departmentally to prioritize compliance efforts and address regulatory requirements. • Implements measures to mitigate potential risks to program integrity. • Ensures best practices are followed to maintain and enhance the quality of nursing activities, ensuring they meet established standards and guidelines. • Engages with governmental and law enforcement stakeholders as required. • Acts independently to assess existing nursing processes for efficiency, effectiveness, and compliance. • Collaborates with other departments, stakeholders, and external entities to ensure a comprehensive approach to program integrity and patient care. • Works closely with the Supervisor - Clinical Review’s staff to manage workload, ensuring timeliness and quality of service delivery. • Maintains accurate documentation of nursing program activities and produces regular reports on metrics related to program integrity, compliance status, and quality. • Instructs nursing staff on compliance and integrity matters, ensuring they understand and adhere to policies and procedures. • Provides job-specific orientation and training as needed. • Manages team performance through regular, timely feedback as well as the formal performance review process to ensure delivery of exceptional services and engagement, motivation, and team development.

🎯 Requirements

• Minimum Bachelor's Degree required • 5 - 7 years of experience required; 8 - 11 years preferred • Current, active and non-restricted RN licensure required • Coding certification preferred