This is a fully remote position, open to applicants in Alaska.

• Provide operational leadership for a team of clinical professionals engaged in utilization management and specialty reviews.

• Ensure clinical quality, adherence to regulatory standards, operational excellence, staff development, and effective financial management.

• Collaborate with Medical Directors, clients, and internal leaders to deliver exceptional clinical services.

• Lead and nurture a team of utilization management clinicians through coaching, mentoring, and performance oversight.

• Oversee initiatives related to quality management and continuous process enhancement.

• Manage departmental productivity, budgets, staffing, and operational performance metrics.

• Collaborate with Medical Directors and cross-functional leaders to establish clinical policies, workflows, and review protocols.

• Foster customer relationships, engage in business development activities, and aid in proposal responses.

• Monitor key performance indicators and implement enhancements to improve service delivery and operational efficiency.

• Active, unrestricted RN license.

• Bachelor's degree in a relevant field (or equivalent experience).

• Five or more years of experience in utilization management and/or case management.

• Two or more years of leadership or management experience, including financial oversight.

• Proven experience in leading clinical teams and promoting operational excellence.

• Certification in utilization management or a related healthcare management field (such as IQCI).

• Experience with Medicaid and/or commercial health insurance.

• Strong understanding of quality improvement, utilization management, and healthcare compliance.

• Fully remote work environment (U.S.).

• Comprehensive medical, dental, and vision coverage.

• 401(k) with company match.

• Generous paid time off and holidays.

• Professional development opportunities.

• A collaborative, mission-driven culture.

Clinical Manager, Care Management

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