Clinical Review Supervisor

Regular Exempt GENERAL DESCRIPTION: The Clinical Review Supervisor oversees and coordinates medical record review operations, staff, and projects related to diagnosis validation, CHRA, healthcare quality measures, risk adjustment, and provider education, ensuring compliance with established standards while driving operational performance, quality outcomes, and continuous improvement in clinical documentation and diagnosis capture. ESSENTIAL FUNCTIONS:
• Develop and manage work plans for Clinical Review Specialists to ensure alignment with organizational goals, policies, procedures, and established performance expectations.
• Support regulatory, accreditation, internal audit, and compliance activities by coordinating clinical review efforts and ensuring project readiness within required timelines.
• Oversee clinical review operations and monitor daily workflow to ensure the timely completion of assigned projects, initiatives, and deliverables.
• Monitor productivity and performance metrics through the evaluation of work plans and production reports to achieve operational objectives and performance targets.
• Collaborate with cross-functional departments and key stakeholders to support project execution and achieve desired business outcomes.
• Identify, assess, and mitigate operational risks by developing, implementing, and monitoring corrective action plans to improve results and ensure compliance with applicable requirements.
• Analyze clinical review processes and identify opportunities to improve diagnosis validation, documentation accuracy, operational efficiency, and overall performance.
• Oversee provider engagement and communications by addressing inquiries, facilitating access to medical records, and supporting educational initiatives to promote effective collaboration.
• Prepare and present operational reports, analyses, and recommendations to leadership to support informed decision-making and continuous performance improvement.
• Supervises, monitors, trains, evaluates, and corrects personnel among others to comply with his/her role as a supervisor, to assure that his/her personnel fulfill their work plan and comply with their essential functions and that they behave following the policies, standards, norms, and procedures of the Company.
• Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.
• May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document. MINIMUM

QUALIFICATIONS:
Education and

Experience:
Bachelor’s Degree in Nursing Sciences. At least three (3) years of experience working in clinical areas and medical record review. At least one (1) year of experience supervising staff. “Proven experience may be replaced by previously established requirements.” Certifications / Licenses: A valid Nurse & Association Nursing Professionals of Puerto Rico license and registration is required. A valid driver's license in the Commonwealth of Puerto Rico is required. Other: Car in good condition and available to travel to different locations in Puerto Rico. Languages: Spanish – Advanced (comprehensive, writing and verbal) English – Intermediate (comprehensive, writing and verbal) “We are an Equal Employment Opportunity Employer and take Affirmative Action to recruit Protected Veterans and Individuals with Disabilities.”