Supervisor, Clinical Quality Review

About the role

The Supervisor, Quality Reviewers is responsible for leading day-to-day clinical review and medical record operations supporting complex, time-sensitive regulatory audits and quality initiatives. This role provides direct supervision, coaching, and workload management for Clinical Quality Review RNs while ensuring audit deliverables, documentation standards, and regulatory timelines are met.

Responsibilities

• Assists Manager with supporting an efficient department operation and workflow
• Ensures workflow is efficient and effective
• Works with other departments to assure workflow is adequate to meet the needs of the project/audit
• Coaches staff through complex, ambiguous, or high-risk audit scenarios
• Identifies and assists in resolution of escalated and/or complex issues
• Supports daily operations and long-range planning for the department
• Collaborates with department and all business segments to ensure that consistent, effective and timely communication occurs
• Performs other duties as assigned

Requirements

• Bachelor's degree or equivalent experience in a related field (Nursing preferred)
• 5 years of relevant clinical healthcare experience beyond degree, including broad-based clinical practice or equivalent clinical review experience
• Minimum 2 years of prior Lead, Supervisor, or Clinical Leadership experience
• 4 years of broad-based nursing or clinical experience, or an equivalent depth of experience within a clinically focused healthcare discipline
• Minimum 2 years of experience in a managed care organization, preferably supporting quality improvement, clinical review, or regulatory audit activities
• Demonstrated experience managing clinical review, quality, or audit work under strict regulatory timelines
• Demonstrated experience and knowledge of regulatory medical record documentation requirements, including:HEDIS and STARSOff‑Season Data CollectionCMS Cost AuditsRADV and Clinical Data Validation
• Knowledge of ICD‑10 and CPT coding
• Operational Leadership & Decision-Making
• Experience leading teams through frequent change and evolving requirements
• Experience making independent operational decisions in fast-paced, highly regulated environments
• Demonstrated ability to balance quality, compliance, and productivity expectations
• Data, Technology & Project Management Skills
• Effective project management skills, including:Use of planning and tracking toolsDevelopment of achievable goals, timelines, and deliverablesInnovative and efficient use of resourcesAdvanced computer skills, including Adobe Acrobat and Microsoft 365 applications (Word, Outlook, PowerPoint, Excel, Teams, SharePoint)
• Communication, Team Leadership & Core Competencies
• Proven team-building, coaching, and mentoring skills
• Excellent customer service, professionalism, and interpersonal communication abilities
• Strong problem-solving and critical thinking skills
• Demonstrated ability to plan, organize, prioritize, and adapt work in response to changing priorities

Skills And Abilities

• Active Registered Nurse (RN) License preferred
• Skills and abilities listed above

Qualifications

• Required qualifications listed above

Benefits

This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka, MN, Madison, WI, Omaha, NE, or St. Louis, MO.

The full salary grade for this position is $78,700 - $134,900. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $78,700 - $118,020. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data.

In addition to compensation, Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica’s compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.