Supervisor, Medical Frailty Review Nurse

Are you a bedside nurse seeking a change from the hospital setting? If you answered "yes", Alliant Health Solutions, a "2026 Best Place to Work and Healthiest Employer", is the place for you!

The Medical Frailty Review Nurse Supervisor oversees daily operations of the Medical Frailty Review Nurse Team supporting Alliant Health Solutions' Medical Frailty services for the Georgia Department of Community Health (DCH). The position supervises nurses responsible for reviewing medical documentation, applying approved Medical Frailty criteria, documenting clinical findings, and completing or routing cases for determinations in accordance with their authorized scope. The Supervisor assigns and balances review workloads, provides clinical and operational guidance, monitors timeliness and review quality, and coordinates resolution of complex or escalated cases. This role promotes consistent, evidence-based review practices, clear documentation, and timely case progression in accordance with established policies and contract requirements. Clinical reviews and determinations must remain within each reviewer's licensure, delegated authority, and approved escalation protocols.

ESSENTIAL JOB FUNCTIONS

• Supervise daily Medical Frailty nursing review activities, including review of medical documentation, application of approved criteria, documentation of clinical findings, and completion or routing of cases within authorized scope.
• Assign and balance review workloads based on referral volume, case complexity, nurse availability, and established priorities; coordinate coverage to maintain continuity of review operations.
• Provide clinical and operational guidance on approved Medical Frailty criteria, review procedures, documentation standards, and escalation protocols; refer questions beyond nursing scope or delegated authority to the appropriate authorized clinical reviewer; onboarding, ongoing training, coaching, day-to-day guidance to review nurses on approved criteria, systems, policies, clinical-review documentation and other performance management.
• Monitor pending reviews, case aging, and turnaround times to identify barriers and ensure timely action within applicable contract requirements and established workflows.

• Conduct routine quality checks of nursing reviews for completeness, accuracy, consistent application of approved criteria, and adequate support for clinical findings; address identified gaps and coordinate corrective follow-up.

• Promote consistency among review nurses through case discussions, review calibration, and clarification of approved criteria; escalate unresolved interpretation questions through established channels.
• Ensure reviews and determinations are completed only by personnel with the required licensure and delegated authority; route cases requiring additional clinical judgment or authorization to the appropriate reviewer.
• Coordinate with case-management staff to resolve incomplete, unmatched, duplicate, or otherwise problematic records that affect clinical-review readiness.
• Identify supplemental medical documentation needed to complete a review and coordinate requests through approved member and provider outreach processes.
• Ensure clinical findings, supporting documentation, review outcomes, and case status are accurately recorded and associated with the correct Medical Frailty case.
• Review complex or escalated cases within authorized scope and coordinate timely consultation or referral when additional clinical review is required.
• Communicate review status, outstanding clinical information needs, and operational barriers to the Program Manager and appropriate internal team members.
• Identify trends in review quality, documentation gaps, workload, and timeliness; recommend workflow improvements and support implementation of approved changes.
• Ensure the team follows established Medical Frailty workflows, approved criteria, job aids, policies, confidentiality requirements, and DCH-approved communications.

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 behaviors.
• 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 as assigned

KNOWLEDGE, SKILLS, AND ABILITIES

• Knowledge of nursing assessment, medical terminology, clinical documentation, and the use of medical records to support clinical review.
• Ability to interpret and consistently apply approved Medical Frailty criteria, policies, and review procedures within nursing scope and delegated authority.
• Knowledge of protected health information safeguards, confidentiality requirements, and secure handling of clinical records.
• Knowledge, skill, and ability to supervise and lead a team, including coaching, communication, and collaboration skills.
• Ability to explain clinical-review requirements and findings clearly to review nurses, case-management staff, and other authorized stakeholders.
• Knowledge, skill and ability to manage time, organize and prioritize work complex work and competing priorities and priorities; and monitor case aging, review quality, and follow-up activities.
• Knowledge, skill and ability to clinical assess and reason with attention to detail, and ability to document objective findings supported by the medical record and recognize missing, conflicting, or insufficient clinical information and identify appropriate next steps or questions beyond nursing scope or delegated authority and follow established consultation and escalation protocols.
• Knowledge, skill and ability to use computers with proficiency with electronic clinical-review systems, medical records, standard office software, and other applications.
• Ability to work independently and remotely with the ability to travel by car or plane to Company locations, customer meetings, or other locations as needed.

EDUCATION, EXPERIENCE, AND TRAINING

Required:

• Current, active, unrestricted Registered Nurse (RN) license valid for the jurisdiction in which assigned nursing review duties are performed.
• Clinical nursing experience and experience reviewing medical records, applying clinical criteria, and documenting clinical findings.
• Experience providing team leadership, staff training, and/or clinical guidance in a healthcare setting.

Preferred:

• Bachelor of Science in Nursing (BSN).
• Experience supervising a nursing review, utilization management, medical review, or related clinical team.
• Experience with Medicaid, Medical Frailty reviews, health-plan operations, or government healthcare programs.
• Experience conducting clinical-review quality checks, review calibration, and workflow improvement.
• Healthcare, government, and/or nonprofit experience.

PHYSICAL REQUIREMENTS

Essential duties are routinely performed in a professional office environment but may be conducted in remote or field locations. The role may require work at a station/desk and routinely requires use of standard office equipment such as computers, phones, photocopiers/scanners, and printers. Duties may require use of transportation to attend meetings or conduct duties outside of the office environment. Must be able to regularly remain in a stationary position and occasionally move about the office to access office machinery and facilities. Occasionally must be able to move/transport materials weighing up to 30 pounds, as well as position self to access files, equipment and work materials. This role frequently communicates to internal and external resources both verbally and written, via face-to-face, online and telephonic media. Must be able to understand and exchange accurate information in these situations, as well as translate into action. Short-term and long-term memory, abstract reasoning and decision making may be required on a regular basis. Core office business operational hours may be required.

ADA/ADAAA/SECTION 503 NOTIFICATION

In compliance with the ADA, the ADA Amendments Act (ADAAA) and Section 503 of the Rehabilitation Act), should you have a disability and would like to request a reasonable accommodation, please see Human Resources to begin the interactive process.

DISCLAIMER

This job description indicates the general nature and level of work expected of the incumbent. It is designed to cover or contain a comprehensive, but not all-inclusive, listing of activities, duties, tasks and/or responsibilities as required for Employee. Employee may be asked to perform other duties and responsibilities as required.

*Pending Award Contract