Clinical Operations Program Manager - Clinical Appeals

📋 Description

• Manage operational projects, market support activities, Clinical Appeals and Utilization Management
• Lead project planning, workflow development, implementation coordination, stakeholder engagement
• Partner with market leadership and clinical operations stakeholders on new market implementations
• Collaborate with Training and Auditing teams on audit tools, readiness activities, process
• Track regulatory and contractual requirements and coordinate updates to workflows, policies, and
• Maintain project plans, action logs, issue trackers, decision logs, status reports, and other

🎯 Requirements

• Bachelor's degree in nursing, business management, or a related field; equivalent relevant
• At least 5 years of healthcare experience.
• At least 2 years of experience in project management, program management, operational
• Experience supporting Utilization Management or Clinical Appeals operations, market
• Clinical licensure is required; an active Registered Nurse (RN) license is preferred.
• Strong knowledge of the healthcare payer industry, including Medicaid and Medicare.

🎁 Benefits

• Salary range of $113,000 to $197,700.
• Potential eligibility for a performance-based bonus tied to individual and organizational
• Comprehensive total rewards package supporting employee well-being.
• Remote work environment within the United States.
• Occasional travel of up to 15% may be required based on departmental needs.
• Opportunity to contribute to meaningful healthcare operations and initiatives affecting members