Clinical Manager - RN - Utilization Management - Full-time (Remote within Arkansas)
Online posting date: 1 day ago. Be among the first 25 applicants.
Company Overview
Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem‑solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.
Job Summary
The Clinical Manager directs and oversees all clinical program activities, emphasizing overall consistency, thoroughness, and accuracy. The primary purpose is to guide the program toward enhanced clinical efficiencies, ensuring that deliverables and assigned contract functions consistently meet the highest standards.
Responsibilities
Conduct Utilization Management (UM) reviews across various specialties as needed.
Manage Care Coordination services for a specific member population.
Provide guidance to direct reports, overseeing utilization management review and case management.
Ensure clinical operations comply with contractual requirements by monitoring critical indicators and adjusting processes to address negative variances.
Identify opportunities for enhancing operating efficiencies.
Serve as a Subject Matter Expert (SME).
Contribute to achieving annual organizational priorities and operational indicators.
Foster effective communication with staff through one‑on‑one meetings, team meetings, and interdepartmental meetings.
Work with the Program Director to manage contract activities including service level agreement metrics, processes, staff development, internal training, review process quality, case management effectiveness, and deliverables.
Manage the clinical quality program, encompassing auditing, Quality Improvement Plans (QIPs), and administration of the Local Quality Improvement Committee.
Perform other duties as assigned.
Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.
Required Qualifications/Experience
Active, unrestricted licensed Registered Nurse (RN) or hold a valid compact state license.
Bachelor's Degree or equivalent directly applicable experience in nursing, or healthcare administration.
2+ years of experience managing clinical Utilization Management (UM) operations.
3+ years of Utilization Review (UR) experience.
Preferred Qualifications/Experience
Knowledge of Arkansas Medicaid and Federal rules and regulations.
Current practical understanding of utilization management, case management, and managed care principles.
Customer‑focused, results‑oriented, with the ability to build and maintain relationships with both internal and external customers.
Organizational and prioritization skills for multiple assignments.
Current knowledge of InterQual and Milliman criteria.Proficient in examining and re‑examining operations and procedures, formulating policy, and developing and implementing new strategies and procedures.
Familiarity with the U.S. healthcare industry.
Experience using systems that support Utilization and Case Management processing.
Understanding of Utilization Review Accreditation Commission (URAC) standards and processes.
Ability to participate as a team member, fostering collaborative decision‑making among leadership, committees, teams, or workgroups of diverse composition.
Proficiency in Microsoft Office applications and other essential software.
Ability to develop, plan, and implement short‑ and long‑range goals.
Demonstrated ability to coach, develop, and manage employee performance effectively.
Capability to provide technical guidance and leadership to the management team.
Advanced verbal and written communication skills, with the ability to work effectively with a wide range of constituencies in a diverse community.
Benefits
Benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.
EEO
Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.