Clinical Program Manager

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

📋 Description

• Direct strategic projects for the Generations Advantage and USFHP business lines.

• Develop, execute, and manage programs aimed at enhancing care transitions, minimizing avoidable readmissions, and improving post-discharge follow-up.

• Ensure adherence to regulatory standards.

• Improve workflows and operational reporting for the integrated whole-person care model.

• Aid in program development, operational reporting, and resource allocation.

• Convert organizational strategy into localized case management action plans.

• Refine case management workflows to boost efficiency and member engagement.

• Enhance data reporting frameworks and pinpoint trends that necessitate clinical interventions.

• Track program benchmarks and key performance indicators (KPIs).

• Detect trends, gaps, and operational risks through performance evaluation.

• Create presentations, communications, and program resources.

• Collaborate with cross-functional leaders to synchronize the care model and execute initiatives.

• Lead committees and working groups addressing program updates, challenges, and financial outcomes.

• Work alongside IT and analytics teams to enhance case management platforms, dashboards, and scorecards.

⛳️ Requirements

• A Bachelor’s Degree in Health Science, Nursing, or a related field is required.

• A minimum of 10 years of experience in healthcare, including managed care, with an emphasis on program management, clinical programs, and process enhancement is required.

• Proficiency in using data analysis to design and oversee programs and ensure program success, including return on investment (ROI), is required.

• Experience in assessing financial and clinical performance metrics is required.

• Familiarity with NCQA case management accreditation standards, audit preparations, and HEDIS quality metrics is required.

• Exceptional oral and written communication and presentation skills.

• Strong organizational capabilities; ability to work autonomously and prioritize tasks.

• Proficiency in computers and business applications, including Microsoft Excel, Visio, Word, PowerPoint, Outlook, and Access.

• Proven track record of implementing and monitoring new clinical programs.

• Demonstrated ability to manage teams and multidisciplinary workgroups without direct authority.

• Keen attention to detail and ability to handle multiple tasks simultaneously.

• Capability to review, interpret, and present information to Health Plan Leadership and external stakeholders.

• Ability to lead change and support the development of change strategies.

• A Master’s degree in Business Administration, Healthcare Administration, or Public Health is preferred.

• Certification as a Case Manager (CCM) or credential from the American Case Management Association (ACMA) is preferred.

• Experience in Medicare Advantage and TRICARE is preferred.

• Familiarity with health IT systems, case management platforms such as TruCare and Salesforce Health Cloud, EHRs, and clinical data analytics reporting tools is preferred.

• This position is not eligible for immigration sponsorship.

🏝️ Benefits

• Medical insurance.

• Dental insurance.

• Vision insurance.

• Retirement savings with employer contributions.

• Paid time off.

• Volunteer time off.

• Pie day.

• Additional employee benefits.

• Potential eligibility for incentive or commission-based programs, where applicable.