Clinical Manager, Care Management
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Job Description
Clinical Manager leading a team in utilization management and clinical operations. Comagine Health improves healthcare quality and outcomes across the country.
Responsibilities:
- Provide operational leadership for a team of clinical professionals performing utilization management and specialty reviews.
- Ensure clinical quality, regulatory compliance, operational excellence, staff development, and financial stewardship.
- Partner with Medical Directors, customers, and internal leaders to deliver outstanding clinical services.
- Lead and develop a team of utilization management clinicians through coaching, mentoring, and performance management.
- Oversee quality management initiatives and continuous process improvement efforts.
- Manage departmental productivity, budgets, staffing, and operational performance.
- Partner with Medical Directors and cross-functional leaders to develop clinical policies, workflows, and review protocols.
- Support customer relationships, participate in business development activities, and contribute to proposal responses.
- Monitor key performance metrics and implement improvements to enhance service delivery and operational effectiveness.
Requirements:
- Active, unrestricted RN license
- Bachelor's degree in a related field (or equivalent experience)
- Five or more years of utilization management and/or case management experience
- Two or more years of leadership or management experience, including financial oversight
- Demonstrated experience leading clinical teams and driving operational excellence
- Certification in utilization management or a related healthcare management field (IQCI or similar)
- Experience with Medicaid and/or commercial health insurance
- Strong knowledge of quality improvement, utilization management, and healthcare compliance
Benefits:
- Fully remote work environment (U.S.)
- Comprehensive medical, dental, and vision coverage
- 401(k) with company match
- Generous paid time off and holidays
- Professional development opportunities
- A collaborative, mission-driven culture
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