Sr Manager Clinical Operations

About the role

This position is responsible for leading and managing the development, implementation, strategic day-to-day administration of managed care operations across clinical functions (Utilization Management, Quality Management, Project Oversight, Accreditation Readiness).

Responsibilities

• Establish and lead teams in the execution of providing clinical operations support to clients to include oversight, processes, procedures and direction for managed care activities.
• Serve as champion of clinical operations to ensure that FEP clinical operations teams enhance the effectiveness, quality and client service objectives our clients expect.
• Aid in the development (along with business leaders and clinical leadership) of processes that ensure the FEP clinical operations are compliant with internal and external requirements.

Requirements

• Licensed Registered Nurse (RN).
• 2 years of experience in a clinical/surgical setting.
• 3 years of management experience.
• Current experience in utilization management position to include pre-authorization, utilization review, concurrent review, discharge planning, and/or skilled nursing facility reviews.
• Knowledge of medical management/nursing practices.
• Analytical skills including presenting clinical/operational recommendations to executive management, Medical Directors, or external clients.
• Problem solving skills.
• Presentation skills including presenting information clearly, concisely, and in a positive manner to internal and external customers.
• Knowledge of Utilization Management metrics, HEDIS and regulatory bodies such as NCQA and URAC.
• Microsoft Office experience.

Preferred

• Registered Nurse (RN) with 2 years direct clinical experience to the consumer.
• 3 years of management experience in a managed health care setting.
• Certification in UM, CM or DM.
• Bachelor's or advanced degree in nursing or Healthcare field.

Benefits

Compensation: $92,700.00 - $167,500.00 Exact compensation may vary based on skills, experience, and location

Pay

$92,700.00 - $167,500.00

Schedule

Flex (Hybrid) role: 3 days in office 2 days remote