Clinical Operations Program Manager--UM Operations

📋 Description

• Manage and prioritize operational projects, market support activities, UM and Clinical Appeals
• Plan and coordinate UM and Clinical Appeals initiatives, including workflow development
• Partner with market leadership and operational stakeholders on new market implementations, product
• Collaborate with Training and Auditing teams on audit tools, documentation, quality monitoring
• Track regulatory and contractual requirements and coordinate updates to workflows and documentation
• Define and prioritize project requirements, reporting needs, process changes, and system impacts

🎯 Requirements

• Bachelor's degree in Nursing, Business Management, or a related field required; equivalent relevant
• At least 5 years of healthcare experience.
• At least 2 years of experience in project management, program management, operational
• Experience with Utilization Management or Clinical Appeals, market implementations, audit
• Clinical licensure required; Registered Nurse (RN) license preferred.
• Six Sigma certification preferred.

🎁 Benefits

• Base salary range of $113,000–$197,700 per year.
• Eligibility for a bonus tied to company and individual performance.
• Remote, full-time position.
• Comprehensive total rewards package supporting employee well-being.
• Occasional travel of up to 15% based on departmental needs.
• Opportunity to work across Utilization Management, Clinical Appeals, healthcare operations