Clinical Program Manager - Remote
$114,957–$142,006 year
RemoteUnited States
Job Summary
Design, implement, and oversee targeted programs for the Generations Advantage and USFHP lines to improve care transitions, reduce avoidable readmissions, and enhance post-discharge follow-up. Streamline case management workflows, optimize data reporting structures, and monitor benchmarks to identify trends requiring clinical interventions. Ensure all initiatives comply with TriCare, CMS, NCQA, and federal regulatory standards while collaborating with cross-functional stakeholders to align strategies with operational excellence. Facilitate committees, develop program tools, and refine software platforms with IT teams to drive continuous program success. This role requires 10 years of healthcare program management experience and is located remotely.
Required Qualifications
- Bachelor's Degree in Health Science, Nursing or related field
- 10 years' experience in healthcare including managed care, with a focus in Program Management, overseeing clinical programs and driving process improvement initiatives
- Experience using data and data analysis to design and monitor programs and manage success, including ROI, of programs
- Experience in evaluating financial and clinical performance metrics
- Demonstrated experience with NCQA case management accreditation standards, audit preparations, and HEDIS quality metrics
Desired Qualifications
- Master's degree in Business Administration (MBA), Healthcare Administration (MHA), or Public Health (MPH)
- Certified Case Manager (CCM) or American Case Management Association (ACMA) certification
- Experience in Medicare Advantage and TRICARE
- Proficiency in health IT systems, including specialized Case Management platforms (e.g., TruCare, Salesforce Health Cloud,), Electronic Health Records (EHRs), and clinical data analytics reporting tools
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