Manager Clinical Review - FEP

Premera Blue Cross•WA Western Telecommuter, WA

7d•$89,300 - $173,200•Remote

About The Position

The Manager of Clinical Review - FEP is a leadership role supporting Premera’s Federal Employee Program and overseeing utilization management (UM) operations. In this role, you’ll lead clinical and support teams, shape UM strategy, and drive outcomes related to quality, member experience, and team performance. You’ll have autonomy, visibility into cross-functional initiatives, and the support of a collaborative leadership team. Key areas of accountability include prospective and retrospective clinical review, concurrent review, clinical appeals, and the clinical call center.

Requirements

Bachelor's degree in a business or healthcare related field or 4 years’ work experience.
1 year of health plan or relevant business experience.
2 years of progressive management experience including experience managing multifunctional teams in multiple locations.
Must be able to align to PST business hours, 8am - 5pm

Nice To Haves

Current Washington licensed registered nurse, licensed mental health professional, licensed pharmacist highly preferred
Experience managing utilization management/clinical review teams highly preferred
Experience with Blue Cross and/or Blue Shield plans.

Responsibilities

Participate in development of clinical review strategy and plan in accordance with company's mission and strategic goals, federal and state law and regulations, and accreditation standards.
Manage and develop teams consisting of diverse clinical and related positions and skill sets.
Promote staff development to support professional growth and operational effectiveness.
Provide timely feedback and coaching on a regular basis to ensure continuous development to meet current and future needs of the business.
Represent department, programs and clinical priorities with senior management and key external stakeholders.
Support the allocation of resources and systems to support implementation of Premera's clinical review strategy and operations.
Provide input and direct support to the development and ongoing measurement of operational metrics and reports.
Coordinate work effort with Sr Manager, Director of Clinical Review and peers of multiple teams to achieve organizational efficiency and effectiveness.
Collect, analyze, maintain and report data on the utilization of medical services, department results and resource use.
Lead and maintain a culture of continuous improvement that positively contributes to the achievement of IHM's and Premera's goals.
Lend business and/or clinical expertise to support business needs.
Develop and manage department budget(s).
Lead, support or participate in special projects as assigned.

Benefits

Medical, vision, and dental coverage with low employee premiums.
Voluntary benefit offerings, including pet insurance for paw parents.
Life and disability insurance.
Retirement programs, including a 401K employer match and a pension plan that is vested after 3 years of service.
Wellness incentives with a wide range of mental well-being resources for you and your dependents, including counseling services, stress management programs, and mindfulness programs.
Generous paid time off to reenergize.
Tuition assistance for both undergraduate and graduate degrees.
Employee recognition program to celebrate anniversaries, team accomplishments, and more.
Commuter perks make your trip to work less impactful on the environment and your wallet.
Free convenient on-site parking.
Subsidized on-campus cafes make lunchtime connections with colleagues fun and affordable.
Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more.
Our complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling.
Challenge someone to a game of shuffleboard or ping pong while on campus.