Clinical Operations Nurse Supervisor

For over 25 years, Revecore has been at the forefront of specialized claims management, helping healthcare providers recover meaningful revenue to enhance quality patient care in their communities. We’re powered by people, driven by technology, and dedicated to our clients and employees. If you’re looking for a collaborative and diverse culture with a great work/life balance, look no further.

About the role

As Revecore’s Clinical Operations Nurse Supervisor, you will supervise a team of nurses on the Clinical Operations Nurse Consultant Team, focusing on optimizing team function for quality and efficiency.

Responsibilities

• Provide supervision to a team of clinicians working to appeal and overturn denials on client claims.
• Supervise Clinical Operations Teams as assigned (Team Leads, Clinical Appeal Nurse Consultants, Transplant Analysts, etc.).
• Evaluate revenue cycle operations, including root-cause analysis, process improvement, staff education, and metric evaluation.
• Support Clinical Case Study presentations for clients in collaboration with department designees and Client Success personnel.
• Support onboarding and training of new nurse hires (onshore and offshore) in collaboration with Revecore Training & Development, Client Success, and offshore vendors.
• Assist the Nurse Manager with workflow implementation and management among nurses.
• Support the Quality Assurance program for all Clinical Operations teams in collaboration with the Revecore Quality Assurance Department.
• Support the Performance Evaluation process for Clinical Operations, ensuring deadlines are met.
• Assist Team Leads with account-related questions related to appeals and denial resolution.
• Provide comprehensive updates to the Nurse Manager/Director regarding client communication, issues, and needs.
• Report staffing and personnel issues to the Nurse Manager as needed.
• Assist in developing, evaluating, and distributing client, payor, and company reports as assigned.
• Support the Nurse Manager and nurses with managing and updating department work plans.
• Prepare and submit correspondence such as appeal letters, emails, online inquiries, adjustments, reports, and other documents if assigned.
• Analyze monthly reports by trends, hospital, payor, and reason to identify operational issues causing denials.
• Collaborate with internal and external teams (vendors, Client Success, Operations, Legal, etc.) to resolve barriers and optimize performance.
• Review managed care contracts, hospital billing statements, and insurance denials to support workflow.
• Support and develop continuing education initiatives in collaboration with Team Leads.
• Communicate with hospital and payor personnel concerning denial-related issues in collaboration with Client Success.
• Present initiatives and results at meetings as requested by Revecore client partners.
• Maintain confidentiality of information in compliance with company policy and HIPAA.
• Maintain regular contact with payors, clients, managers, and other Revecore personnel.
• Attend client, department, and company meetings.
• Comply with federal and state laws, company policies, and procedures.
• Perform other duties as assigned.

Requirements

• Current, valid RN license.
• BSN and/or advanced degree.
• Revenue cycle experience related to Clinical Operations and Utilization Review.
• Clinical nursing experience in a hospital environment, preferably in ER, ICU, Med-Surg, Psych, and/or Transplant units.
• Experience with MCG care guidelines and/or InterQual clinical criteria.
• Preferred: Experience with appeal types such as DRG downgrade, Clinical Validation, Large Claim Audit, Transplant, etc.
• Overall hospital operations experience with multi-disciplinary teams.
• Strong computer proficiency, including Electronic Medical Records, Microsoft Word, and Excel.
• Excellent interpersonal and communication skills.
• Experience with performance improvement tools (variance/root cause analysis, data interpretation, flow charting, metric development).
• Mathematical skills to calculate rates using addition, subtraction, multiplication, and division.
• Ability to read and interpret documents such as contracts, claims, instructions, policies, and procedures in written and diagram form.
• Ability to write routine correspondence in English.
• Ability to define problems, collect data, establish facts, and draw valid conclusions.
• Strong customer service orientation and teamwork skills.
• Commitment to company values.

Work Environment

• Remote position based in the USA.
• A quiet, distraction-free workspace in your home.
• Secure home internet connection with speeds >20 Mbps for downloads and >10 Mbps for uploads.
• Workspace must accommodate all workstation equipment and provide adequate surface area for productivity.

Must reside in one of the following states: Alabama, Arkansas, Florida, Georgia, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Vermont, Virginia, West Virginia, or Wisconsin.

Benefits

• Comprehensive medical, dental, vision, and life insurance benefits from the start of employment.
• 12 paid holidays and flexible paid time off.
• 401(k) contributions.
• Employee Resource Groups that build community.
• Career growth opportunities.
• Excellent work/life balance.