Job Summary

The Registered Nurse Team Lead will oversee a team of US-licensed nurses supporting clinical review, utilization management, and healthcare operations. This role is responsible for ensuring quality standards, productivity, and compliance with healthcare regulations while mentoring and guiding the team in clinical decision-making and operational processes.

Key Responsibilities

• Supervise and manage a team of USRN staff performing clinical reviews, documentation assessments, and utilization management activities.
• Ensure team adherence to operational guidelines, productivity targets, and quality standards.
• Conduct coaching, mentoring, and performance evaluations to support team development.
• Review complex clinical cases and provide guidance on clinical decision-making.
• Collaborate with cross-functional teams to resolve clinical documentation issues and escalate cases as required.
• Support process improvement initiatives to enhance operational efficiency and compliance.
• Ensure compliance with healthcare regulations, payer policies, and organizational standards.
• Maintain accurate reporting of team performance metrics, quality outcomes, and operational data.

Qualifications

• Active and unrestricted US Registered Nurse (USRN) license preferably a New York state license
• Bachelor of Science in Nursing (BSN) graduate
• Minimum 3–5 years of clinical experience in hospital, payer, or healthcare operations.
• Prior experience in utilization review, case management, clinical documentation review, or healthcare appeals preferred.
• Leadership experience or team supervision in a clinical or healthcare operations setting.
• Strong knowledge of US healthcare systems, clinical standards, and payer guidelines.
• Excellent communication, coaching, analytical, and documentation skills.
• Ability to work in a fast-paced, performance-driven environment.