Alliant Health Group is a family of companies that provides professional services supporting the effective administration of healthcare programs and funding to support healthcare improvement initiatives. Alliant Health Solutions provides Federal and state government entities with the services, expertise and information systems necessary to increase the effectiveness, accessibility and value of health care.

Currently, Alliant Health Solutions, a "2023 Best Place to Work and Healthiest Employer", seeks (2) Clinical Supervisors, Waiver Programs. The Clinical Supervisor functions in a dual role. Key responsibilities include supervising a team of clinical and non-clinical staff, providing training and guidance for the team's specific review types, and performing Prior Authorization Reviews.

In this role, the ideal candidate will:

• Perform reviews of initial and reassessment level of care determination for applicants/ clients requesting admission and continued placement to the waiver program.
• Evaluate clinical information and approve cases that meet criteria. Clearly document the rationale for all review decisions using appropriate criteria or nursing judgment.
• Refers cases appropriately to the physician consultant for review when indicated.
• Consult with the Manager, Waiver, or Medical Directors on issues related to cases requiring physician clarification.
• Accomplishes staff results by communicating job expectations; monitoring and appraising job results; coaching, counseling employees; coordinating, and enforcing systems, policies, procedures, compliance, and productivity standards.
• Participates in quality improvement and peer review activities including performance appraisal evaluations on new staff, annual performance evaluations, inter-rater reliability audits.
• Oversight of team assigned Prior Authorization (PA) Types to ensure that the MMURS contract expectations are met/exceeded.
• Creates and monitors team assignments to ensure accuracy and timeliness of medical reviews in accordance with established clinical criteria and both state and federal guidelines.
• Ensures each reviewer is familiar with a variety of review types and the corresponding DCH policies manuals involved.
• Orients and trains new hires to their respective job responsibilities; and may educate staff on process changes, URAC, quality or other needs.
• Perform other duties as assigned.

Other Job Functions

• Work in close collaboration with other team members to support the development of new projects and the continuous improvement of the overall work of the team.
• Promote core values of teamwork, professionalism, effective communication skills and positive behavior.
• Maintain security and confidentiality of all information in accordance with HIPAA laws and regulations and company policies.
• Demonstrate compliance with company corporate and departmental policies as evidenced by attendance, punctuality, and dress.
• Perform other duties, tasks and responsibilities as assigned.

Knowledge, skills and abilities required for this role include:

• Working knowledge of ICD-10-CM, CPT codes, and InterQual criteria preferred.
• Management experience or demonstrated leadership in present staff position required.
• Advance theoretical clinical knowledge base and critical thinking skills.
• Shows ability to perform work with considerable independence by using creative thinking, thorough analysis of problems, and innovative approaches to problem resolution.
• Knowledge of time management and ability to prioritize and organize work.
• Computer literate, including keyboarding up to thirty-five words per minute.
• Excellent interpersonal, written, and verbal skills required.
• Ability to keep information confidential and secure in accordance with HIPAA laws, regulations and company policies.
• Ability to travel as needed "driving" to Atlanta office, customer locations and/or meetings.

Education, experience and training required and preferred for the position are below:

Required:

• Registered Nurse, with three to five years recent clinical experience
• Current Georgia nursing license
• Utilization Management, Nurse Reviewer, and/or Prior Approval experience
• Ability to travel via car throughout the state
• Knowledge of Medicaid Home and Community-Based Waiver Programs

Preferred:

• Bachelor's degree in nursing
• Prior Team Lead, Preceptor or Supervisory experience
• Home Health and Community Health experience
• Utilization Review and Prior Authorization experience

Alliant offers work/life balance and great benefits including medical, dental life, disability, paid-time off, retirement with match and contribution, disability, employee assistance program, parental life, and more. If interested, click the apply icon above to apply.

Alliant Health Group ("the Company) is an Affirmative Action, Equal Opportunity Employer and Drug Free Workplace. In compliance with the American's with Disability Act (ADA) and Amendments Act (ADAAA), all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender, gender identity, national origin, disability or veteran status. If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, please let us know. Likewise, if you are limited in the ability to access or use this online application process and need an alternative method for applying, we will determine an alternative method for you to apply. Please contact 678-527-3000.