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Supervisor, Clinical Operations

Supervisor, Clinical Operations

Job Locations 
US-VA-Glen Allen
Job ID 

Job Description


This position is responsible for supervising LTSS authorizations and clinical operation processes that impact service authorization requests and level of care changes experienced by members to ensure accurate reporting and appropriate care coordination effort.


  • Provides oversight for clinical operation processes such as service authorizations, denials, PIRS, and LOCERI
  • Supervises support staff responsible for reviewing authorizing LTSS services based on Medicaid criteria
  • Supervises staff responsible for entering data into the DMAS portal for PIRS and LOCERI
  • Ensures adherence to turnaround times for LTSS authorizations
  • Collaborates with Medical Directors to ensure consistency of clinical reviews according to established criteria and medical necessity
  • Works with care coordination staff to submit corrections to PIRS and/or LOCERI per DMAS request
  • Develops policies and procedures for clinical operation processes to ensure compliance with the CCC+ contract
  • Serves in an advisory capacity for problem solving, reviewing reports being sent to internal and external customers, reviewing problematic cases, and monitor medical management activities in collaboration with care coordination staff
  • Acts as the VPHP primary point of contact for DMAS escalations, workgroups, training, and reporting related to service authorizations, PIRS, and LOCERI
  • Performs chart audits of service authorizations, PIRS, and LOCERI in collaboration with care coordination staff
  • Performs process training for new and existing staff
  • Maintains resources related to MLTSS operational processes, keeping information up-to-date
  • Supports Manager in ongoing quality improvement initiatives by assisting with collecting and analyzing data as outlined in the program
  • Participates in assigned VPHP meetings to educate providers and/or members (which may occur outside of normal business hours)
  • Maintains confidentiality of member information and VPHP proprietary operational information
  • Maintains current knowledge of VPHP policies and procedures
  • Participates in continuing education activities as appropriate
  • Other duties as assigned



  • Registered Nurse licensed to practice nursing in Virginia
  • BSN preferred
  • Certified Case Manager (CCM) is a plus



  • Strong oral and written communication skills
  • Knowledge of community resources and vendor options and experience in making appropriate referrals
  • Possess strong knowledge of Medicare and Medicaid programs
  • Ability to communicate effectively with individuals who have complex medical and/or behavioral health needs
  • PC literate with working knowledge of Microsoft Office applications



  • Minimum of 3 years working experience in a long term care, home health, behavioral health, or Medicaid managed care setting
  • Knowledgeable of Medicaid waiver criteria for review of LTSS authorizations
  • Prior supervisory experience is preferred
  • Experience working with low-income, disadvantaged, disabled, elderly, and vulnerable populations



  • Physical health sufficient to meet the ergonomic standards and demands of the position.
  • Some local travel will be needed.



About Us

Virginia Premier is a managed care organization which began as a full-service Medicaid MCO in 1995. Partnered with VCU Medical Systems we strive to meet the needs of the underserved and vulnerable populations in Virginia by delivering quality driven, culturally sensitive and financially viable Medicare and Medicaid healthcare programs.  Headquartered in Richmond, VA we also have offices in Roanoke, Tidewater and Bristol with additional satellite locations allowing us to serve over 200,000 members across eighty counties throughout Virginia. 


We offer competitive salaries and a comprehensive benefits package to include excellent Medical, Dental and Vision Plans, Tuition Assistance, Infant-At-Work Program, Remote Work options and generous vacation and sick leave policies. Our culture supports an environment where employees can continuously learn and gain professional growth through various development programs, education, exciting projects and career mobility.  


All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE


Our mission is to inspire healthy living within the communities we serve!


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