Clinical Program Manager

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Must live in Indiana.

Position Purpose

Responsible for managing and tracking clinical projects that advance the objectives of the strategic plan with key provider groups and/or hospital systems by supporting established committees and creating new work teams. Activities include organizing and publishing agendas, documenting minutes, maintaining work plans, and monitoring open action items.

Works closely with the Regional Medical Director to analyze data and develop and implement key interventions to support the Triple Aim, including developing work plans, workflows, policies and procedures, and serving as workgroup leader when appropriate to execute initiatives.

Serves as project leader for cross-functional initiatives intended to drive performance improvement, engaging across functional teams to ensure effective communication of project requirements and tracking progress of action plans.

Facilitates the development of clinical reports and delivery of data to key provider partners, as well as develops internal reports to demonstrate progress. Performs detailed analysis of data, workflows, policies, procedures, and organization of staff to execute initiatives. May use project management software to support initiatives.

• Identifying, managing, and tracking clinical, quality, correct coding, documentation, and data submission projects that advance the Health Plan's strategic goals.
• Facilitating the development of internal and external reports and delivery of data to support and monitor action plans to accomplish the Triple Aim: improving member experience, improving the quality of care, and reducing healthcare costs.

Complies with all policies and standards. Performs other duties as assigned.

Requirements

• Must live in Indiana.
• Clinical RN highly preferred.
• Understanding of clinical pathways.
• Experience with Indiana Medicaid, NCQA, CMS, UM appeals/grievances, delegated/vendor oversight, or health plan audit readiness is preferred.

Education/Experience

• Bachelor’s Degree in Nursing, International Medical Graduate, Master’s Degree in Public Health (MPH), Hospital Administration (MHA), Business Administration (MBA), or equivalent experience.
• Five to seven years of managed care, hospital, or medical group experience, focusing on quality improvement, utilization management, or clinical operations.
• Experience analyzing and presenting data to drive outcomes.
• Experience making presentations in group settings.
• At least two years of project management experience managing a project at any level in a medical group, IPA, or health plan setting.

Pay

Pay Range: $87,700.00 - $157,800.00 per year. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives.

Benefits

• Competitive pay.
• Health insurance.
• 401K and stock purchase plans.
• Tuition reimbursement.
• Paid time off plus holidays.
• Flexible approach to work with remote, hybrid, field, or office work schedules.

Benefits may be subject to program eligibility.