Senior Manager Clinical Review - LH

Luminare Health

2d•$67,600 - $127,000•Remote

About The Position

At Luminare Health, our people are what set us apart. Their expertise, dedication, and passion for service excellence are the foundation of our success. We're committed to helping our employees grow through thoughtful development opportunities, meaningful work, and a culture that values collaboration and continuous improvement. When you join Luminare Health, you join a purpose-driven team focused on making healthcare simpler, better, and more affordable. Job Summary The Senior Manager, Clinical Review is responsible for the daily operations of Clinical Review Department in Healthcare Management in collaboration with the Associate Director, including oversight and accountability for the assigned staff performing the Utilization Management and Claims Medical Management functions and support work for the Utilization Review Program. Also conducts analysis of data as it relates to the Healthcare Management processes and outcomes, determines trends, staffing needs and risks to improve the overall effectiveness and efficiency of the department. Remote employees must live within the continental United States, excluding Alaska, New York, California, or Hawaii.

Requirements

Bachelor's Degree
Active state Registered Nurse license in good standing
7 years' experience in direct clinical care or managed care
3 years of management experience
Prior Utilization Management experience
Communicate in a positive and effective manner in both oral and written communication
Read and interpret documents, criteria, instructions, and policy & procedure manuals
Write/create routine correspondence and reports
Speak effectively with co-workers and senior management
Ability to successfully train adult learners and meet the educational needs of those being trained
Critical thinking skills allowing one to apply common sense to carry out instruction furnished in written, oral or diagram form
Must be able to multi-task in an environment that requires organization and prioritization and the ability to address time sensitive assignments
Maintain a high level of confidentiality, flexibility and willingness to learn new tasks and take on new duties as needed
Work in a dynamic team-oriented environment
Work independently with minimal supervision or instruction.
Demonstrates knowledge of Microsoft Office Suite products.

Nice To Haves

Bachelor of Science in Nursing
Prior supervisory or leadership experience
Clinical Case Manager (CCM) Certification

Responsibilities

Oversee and be accountable for assigned staff performing Utilization Management and Claims Medical Management functions and support work for the Utilization Review Program.
Conduct analysis of data as it relates to Healthcare Management processes and outcomes.
Determine trends, staffing needs, and risks to improve the overall effectiveness and efficiency of the department.
Communicate in a positive and effective manner in both oral and written communication.
Read and interpret documents, criteria, instructions, and policy & procedure manuals.
Write/create routine correspondence and reports.
Speak effectively with co-workers and senior management.
Successfully train adult learners and meet the educational needs of those being trained.
Apply common sense to carry out instructions furnished in written, oral or diagram form.
Multi-task in an environment that requires organization and prioritization and the ability to address time sensitive assignments.
Maintain a high level of confidentiality, flexibility and willingness to learn new tasks and take on new duties as needed.
Work in a dynamic team-oriented environment.
Work independently with minimal supervision or instruction.
Demonstrate knowledge of Microsoft Office Suite products.