Senior Manager, Clinical Program Management (Clinical Operations)
Bristol-Myers SquibbSalary not specified
Manager II Medical Management at Elevance Health
Woodland Hills, California, United States
Not SpecifiedCompensation
Senior (5 to 8 years)Experience Level
Full TimeJob Type
UnknownVisa
HealthcareIndustries
Requirements
- HS diploma or equivalent and a minimum of 5 years acute care clinical experience which includes a minimum of 2 years prior management experience; or any combination of education and experience, which would provide an equivalent background
- Current, active, valid unrestricted RN license to practice as a health professional within the scope of licensure in applicable state(s) or territory of the United States required, except in government business where it is preferred
- Must be within a reasonable commuting distance from the posting location(s), unless an accommodation is granted as required by law (hybrid role requiring in-office 3 days per week)
Responsibilities
- Ensures adherence to medical policy and member benefits in providing service that is medically appropriate, high quality, and cost effective
- Manages areas which may include authorizing inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, programs or community resources
- Applies clinical knowledge to work with facilities and providers for care-coordination
- May also manage appeals for services denied
- Serves as mentor to lower leveled managers and as subject matter expert for other areas of the company and within the department
- Manages multiple functions requiring unique sets of knowledge or has significant fiscal accountability
- Develops and manages annual operating budget
- Hires, trains, coaches, counsels, and evaluates performance of direct reports
Skills
Utilization Review
Care Coordination
Medical Policy
Appeals Management
Budget Management
Team Leadership
Clinical Knowledge
Provider Relations
Elevance Health
Integrated health services and digital platform
About Elevance Health
Elevance Health focuses on enhancing the health of individuals throughout their lives by evolving from a traditional health benefits organization into a comprehensive health partner. The company serves over 118 million people, providing support at every stage of health through an integrated approach that addresses a wide range of health needs. Their services are backed by advanced capabilities and a digital health platform that streamlines access to care. Unlike many competitors, Elevance Health emphasizes a holistic view of health, aiming to redefine health and improve community well-being. The ultimate goal is to make health improvements accessible to everyone.
Indianapolis, IndianaHeadquarters
1944Year Founded
$309.4MTotal Funding
IPOCompany Stage
Enterprise Software, Social Impact, HealthcareIndustries
10,001+Employees
Benefits
Medical, dental, & vision insurance
401(k) + match
Paid holidays
Paid Time Off
Incentive bonus programs
Stock purchase plan
Life insurance
Wellness Programs
Financial education resources
Adoption & Surrogacy Assistance
Dependent-care Flexible Spending Account (DCFSA)
Parental Leave
Parental Transition Week
Critical Caregiving Leave
Risks
Departure of CFO John Gallina may create a gap in financial leadership.
Lawsuit against CMS over MA Star Ratings could lead to financial penalties.
CareBridge integration may face operational challenges, disrupting service delivery.
Differentiation
Elevance Health integrates whole health approach with digital health platform for comprehensive care.
Acquisition of CareBridge enhances home health services within Carelon division.
Strategic partnership with Clayton, Dubilier & Rice aims to innovate primary care delivery.
Upsides
AI integration in home health services can reduce hospital readmissions and improve outcomes.
Predictive analytics support early disease detection, aligning with Elevance's whole health approach.
Telehealth expansion offers opportunities to reach more patients remotely.
Related Jobs
RemoteRemoteSNF Utilization Management RN - Compact Rqd
HumanaSalary not specified
Full Time
Mid-level (3 to 4 years), Senior (5 to 8 years)
RemoteManager, Acute Care Nursing
Imagine PediatricsSalary not specified
RemoteMedical Director - National Outpatient Medicare Team
HumanaSalary not specified
RemoteBilingual Supervisor, Care Management Support
HumanaSalary not specified
RemoteClinical Operations Vendor Manager
Abata TherapeuticsSalary not specified
RemoteUtilization Management Nurse
HumanaSalary not specified
RemoteCase Management Lead
Orca BioSalary not specified
- Full Time
- Senior (5 to 8 years), Expert & Leadership (9+ years)
RemoteCare Coordinator (Remote)
Age BoldSalary not specified
- Full Time
- Entry Level & New Grad
RemoteManager, Behavioral Health
Imagine PediatricsSalary not specified
RemoteSenior Manager, Clinical Medical Writer
Bristol-Myers SquibbSalary not specified
RemoteMedical Director - Medicaid (IL)
CVS HealthSalary not specified
- Full Time
- Senior (5 to 8 years)
RemoteClinical Program Manager
GravieSalary not specified
RemoteCare Manager - NeuroNav
Pear VCSalary not specified
- Full Time
- Mid-level (3 to 4 years), Senior (5 to 8 years)
RemoteMedical Director - Nat'l IP UM Team
HumanaSalary not specified