Mgr., Clinical Care Management

COMAGINE HEALTH• US,

6d•$105,000 - $137,000•Remote

About The Position

The Manager, Clinical Care Management provides operational leadership for a team of clinical professionals performing utilization management and specialty reviews. This role is responsible for ensuring clinical quality, regulatory compliance, operational excellence, staff development, and financial stewardship while partnering with Medical Directors, customers, and internal leaders to deliver outstanding clinical services.

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

Nice To Haves

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

Responsibilities

Lead and develop a team of utilization management clinicians through coaching, mentoring, and performance management.
Ensure compliance with contractual, regulatory, accreditation, and organizational requirements.
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.