State Licensed Clinical Engagement Manager

Job Summary

To enhance operational efficiency and clinical outcomes, the full-time remote Manager of Carrier Engagement will evaluate payment integrity processes, provide clinical expertise in claims review, and lead a team of Clinical Analysts while collaborating with internal and external stakeholders.

Key responsibilities

• Provide data analytics to support client and carrier requests and improve operational workflows
• Lead and mentor the department's Clinical Analysts while managing carrier engagement and clinical processes
• Analyze clinical and operational data to identify trends, gaps, and opportunities for improvement

Required qualifications

• Active clinical license (RN, LPN/LVN) preferred or relevant clinical data 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 a related healthcare role
• Experience reviewing medical records and/or claims data from a payor perspective preferred
• Proven experience as a people leader managing a team in a cross-functional business environment