Clinical Manager, Care Management

About the role

The Clinical Manager, Care Management provides operational leadership for a team of clinical professionals performing utilization management and specialty reviews. This role is responsible for ensuring clinical quality, regulatory compliance, operational excellence, staff development, and financial stewardship while partnering with Medical Directors, customers, and internal leaders to deliver outstanding clinical services.

Responsibilities

• Lead and develop a team of utilization management clinicians through coaching, mentoring, and performance management.
• Ensure compliance with contractual, regulatory, accreditation, and organizational requirements.
• Oversee quality management initiatives and continuous process improvement efforts.
• Manage departmental productivity, budgets, staffing, and operational performance.
• Partner with Medical Directors and cross-functional leaders to develop clinical policies, workflows, and review protocols.
• Support customer relationships, participate in business development activities, and contribute to proposal responses.
• Monitor key performance metrics and implement improvements to enhance service delivery and operational effectiveness.

Requirements

Required Qualifications:

• Active, unrestricted RN license
• Bachelor's degree in a related field (or equivalent experience)
• Five or more years of utilization management and/or case management experience
• Two or more years of leadership or management experience, including financial oversight
• Demonstrated experience leading clinical teams and driving operational excellence

Preferred Qualifications

• Certification in utilization management or a related healthcare management field (IQCI or similar)
• Experience with Medicaid and/or commercial health insurance
• Strong knowledge of quality improvement, utilization management, and healthcare compliance

Benefits

Comagine Health offers a fully remote work environment (U.S.), comprehensive medical, dental, and vision coverage, a 401(k) with company match, generous paid time off and holidays, professional development opportunities, and a collaborative, mission-driven culture.

Pay

N/A

Schedule

N/A