Senior Manager Clinical Review - LH

About the Role

The Senior Manager, Clinical Review is responsible for the daily operations of the Clinical Review Department in Healthcare Management in collaboration with the Associate Director. This includes oversight and accountability for assigned staff performing Utilization Management and Claims Medical Management functions, as well as support work for the Utilization Review Program. The role involves analyzing data related to Healthcare Management processes and outcomes to identify trends, staffing needs, and risks, with the goal of improving the department's overall effectiveness and efficiency. Remote employees must live within the continental United States, excluding Alaska, New York, California, or Hawaii.

Responsibilities

• Oversee and manage the daily operations of the Clinical Review Department.
• Supervise staff performing Utilization Management and Claims Medical Management functions.
• Support the Utilization Review Program.
• Analyze data related to Healthcare Management processes and outcomes to determine trends, staffing needs, and risks.
• Improve the overall effectiveness and efficiency of the department.
• Communicate effectively in both oral and written forms with co-workers and senior management.
• Read, interpret, and apply documents, criteria, instructions, and policy & procedure manuals.
• Write and create routine correspondence and reports.
• Train adult learners and meet their educational needs.
• Apply critical thinking and common sense to carry out instructions.
• Multi-task in a dynamic environment requiring organization, prioritization, and handling of time-sensitive assignments.
• Maintain confidentiality, flexibility, and a willingness to learn new tasks and take on new duties.
• Work in a team-oriented environment and independently with minimal supervision.
• Demonstrate proficiency in Microsoft Office Suite products.

Requirements

• Bachelor’s Degree (Bachelor of Science in Nursing preferred).
• Active state Registered Nurse license in good standing.
• 7 years of experience in direct clinical care or managed care.
• 3 years of management experience.
• Prior Utilization Management experience.
• Remote employees must live within the continental United States, excluding Alaska, New York, California, or Hawaii.

Preferred Qualifications

• Bachelor of Science in Nursing.
• Prior supervisory or leadership experience.
• Clinical Case Manager (CCM) Certification.

Benefits

• Health and wellness benefits.
• 401(k) savings plan.
• Pension plan.
• Paid time off.
• Paid parental leave.
• Disability insurance.
• Supplemental life insurance.
• Employee assistance program.
• Paid holidays.
• Tuition reimbursement.
• Other incentives.

Pay

This role aligns with an annual incentive bonus plan subject to the terms and conditions of the plan. The compensation range for this position is $67,600.00 - $127,000.00 per year. Exact compensation may vary based on skills, experience, and location.