Clinical Program Manager

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🔥 0 minutes ago

🦞 Maine – Remote

🦞 Maine – Remote

💵 $115k - $142k / year

⏰ Full Time

🟠 Senior

🔴 Lead

🏥 Clinical Operations

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Martin's Point Health Care

WebsiteLinkedInAll Job Openings

501 - 1000 employees

🛡️ Insurance

📦 Logistics

💼 Consulting

Insurance • Logistics • Consulting

Martin's Point Health Care is a healthcare organization committed to serving its local communities through high-quality primary and specialty care services. The organization places a strong emphasis on creating a positive workplace culture, recognizing employee contributions, and fostering workforce diversity. Martin's Point Health Care offers a range of career opportunities across various departments, from healthcare providers to corporate roles, and supports employee growth through competitive compensation, development programs, and generous perks. Additionally, the company is recognized for its community impact efforts, raising significant funds for community organizations and encouraging employee volunteerism.

📋 Description

• Lead strategic initiatives for the Generations Advantage and USFHP lines of business • Design, implement, and oversee programs improving care transitions, reducing avoidable readmissions, and enhancing post-discharge follow-up • Ensure compliance with regulatory requirements • Optimize workflows and operational reporting for the integrated whole-person care model • Support program development, operational reporting, and program resources • Translate organizational strategy into localized case management work plans • Streamline case management workflows to improve efficiency and member engagement • Optimize data reporting structures and identify trends requiring clinical interventions • Monitor program benchmarks and KPIs • Identify trends, gaps, and operational risks through performance monitoring • Develop presentations, communications, and program tools • Partner with cross-functional leaders to align the care model and implement initiatives • Facilitate committees and working groups covering program updates, barriers, and financial outcomes • Collaborate with IT and analytics teams to refine case management platforms, dashboards, and scorecards

🎯 Requirements

• Bachelor’s Degree in Health Science, Nursing, or related field required • 10 years’ experience in healthcare, including managed care, with a focus on program management, clinical programs, and process improvement required • Experience using data analysis to design and monitor programs and manage program success, including ROI, required • Experience evaluating financial and clinical performance metrics required • Experience with NCQA case management accreditation standards, audit preparations, and HEDIS quality metrics required • Excellent oral and written communication and presentation skills • Strong organizational skills; ability to work independently and prioritize work • Competence with computers and business applications, including Microsoft Excel, Visio, Word, PowerPoint, Outlook, and Access • Demonstrated track record of driving new clinical programs through implementation and monitoring • Demonstrated expertise managing teams and multidisciplinary workgroups without direct authority • Strong attention to detail and ability to multitask • Ability to review, interpret, and present information to Health Plan Leadership and external partners • Ability to lead change and assist in developing change strategies • Master’s degree in Business Administration, Healthcare Administration, or Public Health preferred • Certified Case Manager (CCM) or American Case Management Association (ACMA) certification preferred • Experience in Medicare Advantage and TRICARE preferred • Proficiency in health IT systems, case management platforms such as TruCare and Salesforce Health Cloud, EHRs, and clinical data analytics reporting tools 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 • Other employee benefits • Potential eligibility for incentive or commission-based programs, where applicable