Clinical Program Manager

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

📋 Description

• Oversee and monitor projects related to clinical quality, accurate coding, documentation, and data submission that align with the strategic objectives of the Health Plan.

• Provide support to existing committees and establish new work teams as necessary.

• Coordinate and distribute agendas, take minutes, maintain work plans, and track unresolved action items.

• Collaborate with the Regional Medical Director to analyze data and design interventions that promote the Triple Aim.

• Create work plans, workflows, policies, and procedures to enhance operational efficiency.

• Act as a workgroup leader when suitable to implement initiatives effectively.

• Spearhead cross-functional performance improvement projects and collaborate with various teams to ensure clear communication of project requirements.

• Monitor the progress of action plans to ensure timely completion.

• Facilitate the development of clinical reports, both internal and external, and deliver data to provider partners.

• Conduct comprehensive analysis of data, workflows, policies, procedures, and organizational structure.

• Utilize project management software to support various initiatives.

• Carry out other duties as assigned.

⛳️ Requirements

• Must reside in Indiana.

• Clinical RN is highly preferred.

• Experience with Indiana (MHS) Medicaid is preferred.

• Familiarity with clinical pathways is essential.

• Experience with Indiana Medicaid, NCQA, CMS, UM appeals/grievances, delegated/vendor oversight, or health plan audit readiness is preferred.

• Bachelor's Degree in Nursing, International Medical Graduate, Master's Degree in Public Health (MPH), Hospital Administration (MHA), Business Administration (MBA), or equivalent experience.

• Between five to seven years of experience in managed care, hospital, or medical group settings, with a focus on quality improvement, utilization management, or clinical operations.

• Proven experience in analyzing and presenting data to influence outcomes.

• Experience in delivering presentations in group settings.

• A minimum of two years of project management experience in any capacity within a medical group, IPA, or health plan environment.

• Ability to adhere to all policies and standards.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase plans available.

• Tuition reimbursement options.

• Paid time off in addition to holidays.

• Flexible work arrangements, including remote, hybrid, field, or office schedules.

• Additional incentive forms may be included in the overall compensation package.