[Hiring] Senior Manager Clinical Review @Luminare Health

Role Description

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, including:

• Oversight and accountability for the assigned staff performing the Utilization Management and Claims Medical Management functions.
• Support work for the Utilization Review Program.
• Conduct analysis of data as it relates to the Healthcare Management processes and outcomes.
• Determine trends, staffing needs, and risks to improve the overall effectiveness and efficiency of the department.

Remote employees must live within the continental United States, excluding Alaska, New York, California, or Hawaii.

Qualifications

• Bachelor's Degree
• Active state Registered Nurse license in good standing
• 7 years' experience in direct clinical care or managed care
• 3 years of management experience
• Prior Utilization Management experience

Requirements

• Communicate in a positive and effective manner in both oral and written communication
• Read and interpret documents, criteria, instructions, and policy & procedure manuals
• Write/create routine correspondence and reports
• Speak effectively with co-workers and senior management
• Ability to successfully train adult learners and meet the educational needs of those being trained
• Critical thinking skills allowing one to apply common sense to carry out instruction furnished in written, oral, or diagram form
• Must be able to multi-task in an environment that requires organization and prioritization and the ability to address time-sensitive assignments
• Maintain a high level of confidentiality, flexibility, and willingness to learn new tasks and take on new duties as needed
• Work in a dynamic team-oriented environment
• Work independently with minimal supervision or instruction
• Demonstrates knowledge of Microsoft Office Suite products

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

Company Description

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

Min to Max Range: $67,600.00 - $127,000.00

Exact compensation may vary based on skills, experience, and location.