Manager I - Clinical Solutions Manager
$94,000–$162,150 year
HybridAtlanta, Georgia, United States or Denver, Colorado, United States
Job Summary
Lead a team of clinical and non-clinical staff responsible for managing work after physician review, ensuring complex cases are handled accurately, on time, and in accordance with company policies and regulatory requirements. Research and resolve complex escalated cases requiring quick turnaround, while partnering with physicians and internal teams to remove barriers, improve workflows, and support better outcomes for providers and members. Ensure adherence to medical policy and member benefits to authorize inpatient admissions, outpatient services, and diagnostic procedures by accurately interpreting benefits and steering members to appropriate providers. Hire, train, coach, counsel, and evaluate the performance of direct reports to drive timely issue resolution and operational improvements.
Required Qualifications
- HS diploma or equivalent
- minimum of 5 years acute care clinical experience
- 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 practice in applicable state(s) or territory of the United States
- Hybrid work schedule (in-office 3 days per week)
- 40 hours per week across 5 days
- Saturday off
- Sunday off
- one weekday off determined based on business needs
- Location(s): Nevada, Colorado, Virginia
- COVID-19 vaccination
- Influenza vaccination
Desired Qualifications
- Strong oral, written and interpersonal communication skills
- problem-solving skills
- facilitation skills
- analytical skills
- Strong leadership skills, including coaching, performance management, and development of direct reports
- Experience managing complex escalations and driving timely issue resolution
- Strong collaboration skills with physicians, providers, and cross-functional business partners
- Knowledge of medical policy interpretation, utilization management, and care coordination processes
- Strong decision-making, prioritization, communication, and analytical skills
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