Quality Assurance Supervisor (Clinical RN)

ABOUT MACHINIFY:In October 2025, Machinify acquired Performant and we are now part of the Machinify organization. Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plans. Deployed by over 75 health plans, including many of the top 20, and representing more than 170 million lives, Machinify’s AI operating system, combined with proven expertise, untangles healthcare data to deliver industry-leading speed, quality, and accuracy. We’re reshaping healthcare payment through seamless intelligence. ABOUT THE OPPORTUNITY:Hiring Range: $95,000 - $105,000The Supervisor, Quality Assurance (Clinical) leverages their nursing background, clinical review, and experience leading others to manage staff and operational results for a remote team of nurses and other audit roles, performing clinical review audits. The Supervisor is primarily responsible for leveraging first-hand experience and knowledge of claims auditing, supporting management with strategy activities such as needs assessments, capacity planning, preparing staffing models, ensuring required staffing levels, cost/benefit analysis, and establishing productivity and quality standards.Key Responsibilities:Contributes to positive team environment that fosters open communication, sharing of information, continuous improvement, and optimized business results. Regularly Performs audit quality assurance reviews to supplement QA team activity as necessary based upon business need or special projects.Contributes to the resolution of quality review rebuttals.Actively identifies and recommends opportunities for cost savings and improving outcomes that can have a direct impact to the company's profitability.Effectively contributes to the development of medical review guidelines and training.Supports audit management and segment specialists with activities for new concept implementation, maintenance of medical review guidelines for existing concepts.Use data, reports, and experience to identify potential backlogs and align resources to meet business needs and SLAs.Collaborate with other departments to resolve operational problems.Proactively monitors and in alignment with applicable management ensures activity required to meet team staffing levels necessary for assigned business segment objectives. Provides support as needed to ensure auditors are equipped with tools and resources required to perform audits.Supervise daily activities of quality assurance teamProvide audit guidance to QA team; identify trends and present solutions.Provides production and quality performance-based progress reports, coaching, and constructive feedback to staff. Manages team Time and Attendance (time off/use of accruals, attendance, attendance points and timecards for hourly staff, etc.) in accordance with applicable policies and procedures.Collaborates with HR for applicable corrective action as applicable.Complete and conduct performance reviews for assigned staff.Routinely review QA scorecards for accuracy and education, QA of the QA.Conduct team meetings with direct reports on a regular basis. Provide leadership to team members, provide solutions, and resolve conflicts. Escalate to management and collaborate with HR as applicable to bring appropriate solutions to employee matters.Provide reporting and updates to management as required and appropriate for operational and staff activity and results. Participates in and contributes to applicable department meetings.May support management with activities to monitor inventory and activity of 3rdparty/subcontractors.Become subject matter expert for assigned business segment(s).Maintain current knowledge and changes that affect our industry and clients as it pertains to medical practice, technology, regulations, legislation, and business trends.May support training material/tools and best practices development.Identify needs and ensure team receives necessary training.Support training activities for new audit staff or provide supplemental training for existing staff as needed.Receives feedback and adjusts work priority for self and team as necessary.Leads by example and conducts work in accordance with company policies, government regulations and law.Serves as positive role model and demonstrates characteristics that align and contribute to a collaborative culture of continuous improvement and high performing teams.Perform other incidental and related duties as required and assigned to meet business needs.Knowledge Skills and Abilities Needed:Flexibility to handle any non-standard situations that may arise. Ability to multitask and work independently in a remote setting.Knowledge of laws, regulations, or policies impacting the Healthcare industry and understanding of Managed Care requirements under the Medicare/Medicaid and other third-party payor programs. (Commercial, OIG, etc.)Solution oriented with focus on innovative and proact