Manager Clinical Program Management & Vendor Performance

Arkansas Blue Cross Blue Shield • Arkansas Remote, AR

17h • Onsite

About The Position

The Manager of Clinical Program Management and Vendor Performance will compile reporting related to the performance and continuous improvement of Utilization Management (UM), Care Management (CM) and vendor programs. This role collaborates across clinical, operational and analytic teams for all lines of business to ensure compliant and high quality member centered outcomes. The Manager supports program monitoring, reporting, vendor performance management, and execution of internal operational improvements and vendor oversight for compliance requirements.

Requirements

• Bachelor’s degree in healthcare administration, public health, social work or related field required.
• Minimum seven (7) years' experience Utilization Management or Care Management OR applicable master’s with minimum five (5) years’ experience.
• Minimum two (2) years’ leadership experience (team, role, and/or project management).
• Minimum of two (2) years demonstrated experience in reporting or dashboarding for program management to track key performance indicators.
• Strong knowledge of Utilization Management or Care Management workflows, documentation standards, and care coordination processes.
• Demonstrated critical thinking and sound judgment.
• Ability to interpret performance data, identify trends, and develop actionable recommendations.
• Ability to lead requirements development and collaborate with data team to develop reporting and dashboarding for program monitoring.

Nice To Haves

• Master’s degree in nursing preferred.
• Clinical licensure such as Registered Nurse (RN), Licensed Practice Nurse (LPN), and/or Social Work (SW) preferred.
• Knowledge of Utilization Review Accreditation Commission (URAC) Utilization Management/Care Management standards preferred.
• Experience managing or working with external vendors preferred.
• Knowledge of Utilization Review Accreditation Commission (URAC) Utilization Management/Care Management standards preferred.

Responsibilities

• Collaborates with analytics and business teams to maintain and improve dashboards and reporting tools.
• Conducts research and assists with workflow assessments to support operational improvements.
• Ensures program compliance with regulatory, contractual, and audit expectations, including Utilization Management/Care Management standards.
• Facilitates recurring vendor meetings, prepares agendas, documents updates, and drives follow‑up actions.
• Facilitates Utilization Management and Care Management Oversight Committee meetings and participates in Stakeholder Oversight Committee meetings to deliver UM and CM performance reporting.
• Facilitates working sessions with stakeholders to resolve program and process challenges.
• Identifies barriers to vendor or program performance and partners with internal teams and vendors to address and resolve issues.
• Implements a quarterly vendor performance program for Utilization Management and Care Management programs, serving as the primary operational point of contact.
• Monitors vendor adherence to Service Level Agreements (SLAs), Key Performance Indicators (KPIs), and contractual requirements and supports timely resolution of issues/complaints.
• Prepares summaries of program performance, risks, and operational recommendations for leadership.
• Reviews and analyzes internal and vendor program data to identify performance trends, risks, and improvement opportunities.

Benefits

• Tuition reimbursement.
• Club Blue, a free, onsite gym to encourage exercise.
• Green Leaf Grill and Green Leaf Grill Express, onsite restaurants in Little Rock that promote healthy eating.
• Incentives for wellness education and exercise

What This Job Offers

• Job Type: Full-time
• Career Level: Manager