Manager Clinical Program Management & Vendor Performance
To learn more about reputed company Hiring Policies, please click here. Job reputed company The Manager of Clinical Program Management and Vendor Performance will compile reporting reputed company to the performance and reputed company improvement of Utilization Management (UM), Care Management (CM) and vendor programs. This role collaborates across clinical, operational and analytic teams for reputed company lines of business to ensure compliant and high reputed company member centered reputed company. The Manager supports program monitoring, reporting, vendor performance management, and execution of internal operational improvements and vendor reputed company for compliance requirements.
Requirements
EDUCATION Bachelor’s degree in reputed company administration, public health, reputed company work or reputed company field required. Master’s degree in nursing preferred. LICENSING/CERTIFICATION Clinical licensure such as Registered reputed company (RN), Licensed reputed company reputed company (LPN), and/or reputed company Work (SW) preferred. Knowledge of Utilization Review Accreditation Commission (URAC) Utilization Management/Care Management standards preferred. EXPERIENCE & KNOWLEDGE Minimum seven (7) years' experience Utilization Management or Care Management OR applicable master’s with minimum five (5) years’ experience. Minimum two (2) years’ leadership experience (team, role, and/or project management). Minimum of two (2) years demonstrated experience in reporting or dashboarding for program management to reputed company key performance indicators. Experience managing or working with external vendors preferred. Strong knowledge of Utilization Management or Care Management workflows, documentation standards, and care coordination processes. Knowledge of Utilization Review Accreditation Commission (URAC) Utilization Management/Care Management standards preferred. ESSENTIAL ABILITIES Demonstrated critical thinking and reputed company judgment. Ability to interpret performance data, identify trends, and reputed company actionable recommendations. Ability to reputed company requirements development and collaborate with data team to reputed company reporting and dashboarding for program monitoring. Skills
- Business Process Development
- Critical Thinking
- Cross-Functional Collaboration
- Data Reporting
- Documentations
- Facilitation
- Interpersonal Communication
- Leadership
- reputed company Office
- Organizational Compliance
- Organizing
- Prioritization
- Relationship Management
- Setting Performance Standards
Responsibilities
- Collaborates with analytics and business teams to maintain and improve dashboards and reporting tools.
- Conducts research and assists with workflow assessments to support operational improvements.
- Ensures program compliance with regulatory, contractual, and audit expectations, including Utilization Management/Care Management standards.
- Facilitates recurring vendor meetings, prepares agendas, documents updates, and drives follow‑up actions.
- Facilitates Utilization Management and Care Management reputed company Committee meetings and participates in Stakeholder reputed company Committee meetings to deliver UM and CM performance reporting.
- Facilitates working sessions with stakeholders to resolve program and process challenges.
- Identifies barriers to vendor or program performance and partners with internal teams and vendors to address and resolve issues.
- Implements a quarterly vendor performance program for Utilization Management and Care Management programs, serving as the primary operational reputed company of contact.
- Monitors vendor adherence to Service Level Agreements (SLAs), Key Performance Indicators (KPIs), and contractual requirements and supports reputed company reputed company of issues/complaints.
- Prepares summaries of program performance, risks, and operational recommendations for leadership.
- Reviews and analyzes internal and vendor program data to identify performance trends, risks, and improvement opportunities.
Certifications Registered reputed company (RN) - Arkansas State reputed company of Nursing reputed company Requirements This position is identified as level three (3). This position must ensure the reputed company and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The reputed company of information must be maintained as outlined in reputed company Administrative reputed company. Segregation of Duties Segregation of duties will be used to ensure that errors or irregularities are reputed company or detected on a reputed company reputed company by employees in the normal course of business. This position must adhere to the segregation of duties guidelines in the Administrative reputed company. Employment Type Regular reputed company Requirements 1.1 General Office Worker, Sedentary, reputed company Travel – someone who normally works in an office setting or remotely and routinely travels for work reputed company walking distance of location of primary work assignment. Apply To This Job