Licensed Clinical Operations Manager

Job Summary

A company is looking for a Manager of Carrier Engagement.

Key Responsibilities

• Provide clinical expertise to support operational workflows and review claims data and medical records
• Lead and mentor the department's Clinical Analysts while managing carrier engagement
• Analyze clinical and operational data to identify patterns and opportunities for improvement

Qualifications

• Active clinical license (RN, LPN/LVN) preferred or relevant clinical experience
• Bachelor's degree in Nursing, Healthcare Administration, Business, or related field; advanced degree a plus
• 5+ years of experience in clinical operations, utilization management, or related healthcare role
• Preferred experience in reviewing medical records and claims data from a payor perspective
• Experience in a cross-functional business environment and managing a team is strongly preferred