Manager, Clinical Operations

🔥 23 hours ago

🇺🇸 United States – Remote

💵 $85k - $90k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🏥 Clinical Operations

👻 Ghost score 0%

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Lucet

WebsiteLinkedInAll Job Openings

501 - 1000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

☁️ SaaS

Healthcare • Healthcare Insurance • SaaS

Lucet is a tech-enabled behavioral health company that combines human care teams and digital tools to connect individuals to timely, in-network mental health and substance-use care. It partners with health plans, employers, providers, and members through portals (employer/HR, member, provider, partner) and services such as EAP, care navigation, and provider resources to optimize access, quality, and value-driven behavioral healthcare.

📋 Description

• Lead Benefit Determination Unit operations, ensuring timely, accurate, and compliant utilization management activities • Oversee performance, resource utilization, complex case escalations, and operational initiatives to drive efficiency and service excellence • Ensure compliance with regulatory, accreditation, contractual, and organizational requirements • Oversee utilization management processes and quality activities • Monitor performance metrics, audits, and operational reviews • Implement improvements and corrective actions to enhance quality, efficiency, and outcomes • Lead, coach, and develop a high-performing team • Foster accountability, collaboration, and continuous improvement • Partner with appeals teams, health plans, providers, clients, and internal stakeholders • Support coordinated care, effective benefit determinations, and client satisfaction

🎯 Requirements

• Current, active, and unrestricted license issued by a state or territory of the United States to practice independently with a legal scope of practice permitting independent assessments; eligible professions include Clinical Social Worker, Marriage and Family Therapist, Professional Counselor, Clinical Psychologist, or Registered Nurse • Bachelor's degree in Nursing, Social Work, Counseling, Psychology, or a related healthcare field • 5+ years of clinical experience in utilization management, care management, behavioral health, healthcare operations, or a related clinical setting • 3+ years of experience in a formal clinical supervisory position or demonstrated leadership capacity • Strong knowledge of utilization management principles, medical necessity criteria, benefit determination processes, appeals, and clinical review functions • Working knowledge of state and federal regulatory requirements, accreditation standards (e.g., NCQA, URAC), and health plan contractual obligations • Experience analyzing performance metrics, managing operational workflows, and leading quality improvement initiatives • Excellent communication, stakeholder management, problem-solving, and decision-making skills • Proficiency with clinical documentation systems, care management platforms, and Microsoft Office applications • Obtain certification in Case Management (CCM) within 3 years when applicable to overseeing care management teams • Ability to travel 10% of the time • Ability to pass background checks and screenings upon hire and throughout employment, including criminal records, sanctions/exclusions, education and employment verification, drug screening, and E-Verify • Professional demeanor and ability to collaborate with multiple levels of professionals and staff • Strong attention to detail • Ability to manage multiple tasks in a fast-paced, changing environment • Ability to assume a lead role in ensuring objectives are met • Quiet workspace with minimal background noise for calls • High-speed internet installed before starting, with minimum download speed of 20 Mbps, upload speed of 5 Mbps, and maximum latency of 100 milliseconds

🏖️ Benefits

• Annual performance-based, discretionary incentive • Medical, dental, and vision coverage • 401(k) with competitive employer match • Company-paid life and disability insurance • Paid parental leave and wellbeing incentives • Generous paid time off, including volunteer time • Flexible spending accounts for healthcare and dependent care • Professional development opportunities and tuition reimbursement • Remote work flexibility (role-dependent) • Company-provided equipment • Opportunity for meaningful growth, both personally and professionally