Manager Clinical Review - FEP

$89.3k - $151.8k

Premera

Seattle, WA

# Manager Clinical Review - FEPApplylocations: Telecommutertime type: Full timeposted on: Posted Yesterdayjob requisition id: R28931**Workforce Classification:**Telecommuter**Join Our Team: Do Meaningful Work and Improve People’s Lives**Our purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.Premera is committed to being a workplace where people feel empowered to grow, innovate, and lead with purpose. By investing in our employees and fostering a culture of collaboration and continuous development, we’re able to better serve our customers. It’s this commitment that has earned us recognition as one of the best companies to work for. Learn more about our recent awards and recognitions as a greatest workplace.Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog: **Manager of Clinical Review - FEP** is a leadership role supporting Premera’s Federal Employee Program and overseeing utilization management (UM) operations. In this role, you’ll lead clinical and support teams, shape UM strategy, and drive outcomes related to quality, member experience, and team performance. You’ll have autonomy, visibility into cross-functional initiatives, and the support of a collaborative leadership team. Key areas of accountability include prospective and retrospective clinical review, concurrent review, clinical appeals, and the clinical call center.**What you’ll do:*** Participate in development of clinical review strategy and plan in accordance with company's mission and strategic goals, federal and state law and regulations, and accreditation standards.* Manage and develop teams consisting of diverse clinical and related positions and skill sets. Promote staff development to support professional growth and operational effectiveness. Provide timely feedback and coaching on a regular basis to ensure continuous development to meet current and future needs of the business.* Represent department, programs and clinical priorities with senior management and key external stakeholders.* Support the allocation of resources and systems to support implementation of Premera's clinical review strategy and operations.* Provide input and direct support to the development and ongoing measurement of operational metrics and reports.* Coordinate work effort with Sr Manager, Director of Clinical Review and peers of multiple teams to achieve organizational efficiency and effectiveness.* Collect, analyze, maintain and report data on the utilization of medical services, department results and resource use.* Lead and maintain a culture of continuous improvement that positively contributes to the achievement of IHM's and Premera's goals.* Lend business and/or clinical expertise to support business needs.* Develop and manage department budget(s).* Lead, support or participate in special projects as assigned.**What you’ll bring:*** Bachelor's degree in a business or healthcare related field or 4 years’ work experience. **(Required)*** 1 year of health plan or relevant business experience. **(Required)*** 2 years of progressive management experience including experience managing multifunctional teams in multiple locations. **(Required)*** Current Washington licensed registered nurse, licensed mental health professional, licensed pharmacist highly preferred* Experience managing utilization management/clinical review teams highly preferred* Experience with Blue Cross and/or Blue Shield plans.* Must be able to align to PST business hours, 8am - 5pm**Premera total rewards**Our comprehensive total rewards package provides support, resources, and opportunities to help employees thrive and grow. Our total rewards are more than a collection of perks, they're a reflection of our commitment to your health and well-being. We offer a broad array of rewards including physical, financial, emotional, and community benefits, including:* Medical, vision, and dental coverage with low employee premiums.* Voluntary benefit offerings, including pet insurance for paw parents.* Life and disability insurance.* Retirement programs, including a 401K employer match and, believe it or not, a pension plan that is vested after 3 years of service.* Wellness incentives with a wide range of mental well-being resources for you and your dependents, including counseling services, stress management programs, and mindfulness programs, just to name a few.* Generous paid time off to reenergize.* Looking for continuing education? We have tuition assistance for both undergraduate and graduate degrees.* Employee recognition program to celebrate anniversaries, team accomplishments, and more.For our hybrid employees, our on-campus model provides flexibility to create your own routine with access to on-site resources, networking opportunities, and team engagement.* Commuter perks make your trip to work less impactful on the environment and your wallet.* Free convenient on-site parking.* Subsidized on-campus cafes make lunchtime connections with colleagues fun and affordable.* Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more.* Our complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling.* Need a brain break? Challenge someone to a game of shuffleboard or ping pong while on campus.**Equal employment opportunity/affirmative action:**Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at View email address on click.appcast.io or via phone at View phone number on click.appcast.io.**Premera is hiring in the following states, with some limitations based on role or city:** Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, Wisconsin*.*The pay for this role will vary based on a range of factors including, but not limited to, a candidate’s geographic location, market conditions, and specific skills and experience.The salary range for this role is posted below; we generally target up to and around the midpoint of the range.**National Salary Range:**$89,300.00 - $151,800.00**National Plus Salary Range:**$101,900.00 - $173,200.00*\*National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska**.*We’re happy to discuss compensation further during the interview because we believe that open communication leads to better outcomes for all. We’re committed to creating an environment where all employees are celebrated for their unique skills and contributions.
J-18808-Ljbffr Premera

Apply

Vacancy posted 2 days ago

Similar jobs that could be interesting for youBased on the Manager Clinical Review - FEP in Seattle, WA vacancy

Clinical Consultant, Pharmacokinetics Lab Director - Per Diem
$91.05 - $151.72 per hour
...center in Washington. Position Summary The Clinical Consultant, Pharmacokinetics Lab Director works closely with Directors and Manager to support the scientific and technical... ...pharmacogenetics (PGx). This role performs clinical case review and sign‑out consistently, ensuring...
Suggested
Hourly pay
Daily paid
Work experience placement
Remote work
Shift work
Fred Hutchinson Cancer Research Center
Seattle, WA
3 days ago
Behavioral Health Clinical Supervisor
$80k
...medical, dental, and behavioral health clinics and a wide variety of nutritional, social... ..., and directing work; assisting Program Manager with hiring and staff evaluations; rewarding... ...directing work/caseloads for employees. Reviewing client charts to ensure compliance with...
Suggested
Full time
Contract work
Internship
Work at office
SeaMar Community Health Centers
Seattle, WA
3 days ago
Medical Director
$135k - $180k
...Medical Director, you will combine your clinical expertise with strategic leadership to guide... ...Pillars and Core Competencies. DVM Team Management: Oversee the performance, development,... ...work environment. Medical Record Review: Actively engage in medical record review...
Suggested
Local area
Flexible hours
Cara Veterinary
Mercer Island, WA
4 days ago
Medical Director
$170k - $200k
...providing strong leadership for the hospital, managing and mentoring associate veterinarians,... ...on investment Sees patients and handles clinical practice Ensures positive communication... ...of patient care responsibilities Reviews patient records for completeness and accuracy...
Suggested
Temporary work
Locum
Local area
Relocation package
Flexible hours
Madisonparkvet
Seattle, WA
2 days ago
Medical Director
...responsibility for medical operations, medication management systems, regulatory compliance, and... ...collaboratively with senior leadership, clinical leadership, and operations to strengthen... ..., and co-occurring medical conditions. Review patient medication regimens for safety,...
Suggested
Flexible hours
Shift work
Keyrecovery
Seattle, WA
4 days ago
Medical Director
...Diversity Nimble Fight for What’s Right Please review our Advocacy page for the latest news on... ...centers, pharmacies and wellness clinics. We are now looking for a Family Practice... ...health research Full support team of Practice Manager, MA, and RNs PSLF CME stipend...
Relocation
Weekend work
AIDS Healthcare Foundation
Seattle, WA
4 days ago
Medical Director
$134 - $155 per hour
...responding to employees’ immediate health needs, and overseeing wellness clinic operations. This position is contingent upon award. The hourly... ...until filled or withdrawn. Core Duties Approve and periodically review written clinical protocols, standing orders, and referral...
Hourly pay
Local area
Immediate start
Cape Fox Corporation
Seattle, WA
2 days ago
Medical Director
$180k - $200k
...base, from the ground up. You will own the clinical strategy, operating model, and standard... ..., supervising the clinical team, reviewing care processes, and seeing patients when... ...escalation, documentation, follow-up, and care management. Supervise and support providers, nurses...
Full time
Remote work
Veracity Selfcare
Seattle, WA
4 days ago
Medical Director
$170k - $200k
...providing strong leadership for the hospital, managing and mentoring associate veterinarians,... ...of patient care responsibilities. Reviewing patient records for completeness and accuracy... ...practice. Strong diagnostic and clinical skills. Excellent surgical and dental skills...
Temporary work
Local area
Relocation package
Madison Park Veterinary Hospital
Seattle, WA
2 days ago
Associate Medical Director
...Medical Directors, assisting in auditing cases where necessary, and reviewing areas of dispute in more complex cases. The successful... ...of company business lines. Ability to apply critical thinking, manage time efficiently, and meet specific deadlines. Computer literacy...
Part time
Work from home
Dane Street
Seattle, WA
3 days ago
Medical Director
...Nimble Fight for What's Right Please review our Advocacy page for the latest news on... ...centers, pharmacies and wellness clinics. We are now looking for a Family Practice... ...research ~ Full support team of Practice Manager, MA, and RNs ~ PSLF ~ CME stipend...
Relocation
Weekend work
AIDS Healthcare Foundation
Seattle, WA
4 days ago
Veterinary Practice Manager
$35 - $40 per hour
...Job Summary The Practice Manager plays a vital role in the hospital's leadership under the guidance of the Principal Doctor. Primary... ...competitive pay and a great benefits package. Please review our benefits package at: Compensation : $35.00 - $40...
Hourly pay
Work at office
Local area
Remote work
Shift work
Afternoon shift
WellHaven PetHealth
Renton, WA
3 days ago
Practice Manager
...Practice Manager The Practice Manager "PM" has accountability of all aspects of the location business operations. As a team leader... ...goals through superior service Ensures the daily sales are reviewed identifies gaps and places solutions in place to close the gap...
Full time
Work at office
AEG Vision
Bellevue, WA
5 days ago
Practice Administrator (MFM Office)
$120k - $196k
...regular site visits to satellite and outreach clinics for process analysis to ensure efficiency... ...and practice initiatives and needs. Manages and/or oversees the recruiting, interviewing... ...departments. Actively monitors and reviews monthly financial, operational and revenue...
Work at office
Local area
Direct Jobs
Bellevue, WA
3 days ago
Practice Manager
$125k - $180k
...Acquisition Team requires: General Description: The Practice Manager has overall responsibility for functions relating to a specific... ...projects and initiatives. • Monitor project health and reviews deliverables across projects. • Industry Understanding • Responsible...
Permanent employment
Full time
Temporary work
Work experience placement
Local area
Remote work
TEKsystems
Seattle, WA
3 days ago
Practice Manager
$65k - $111k
...The Practice Manager "PM" has accountability of all aspects of the location business operations. As a team leader at a "people first"... ...various goals through superior service Ensures the daily sales are reviewed identifies gaps and places solutions in place to close the gap...
Full time
Part time
Work at office
RadNet
Bellevue, WA
5 days ago
Clinical Supervisor
$80k
...medical, dental, and behavioral health clinics and a wide variety of nutritional, social... ...coordinates with the Behavioral Health Program Manager regarding administrative and clinical... ...directing work/caseloads for employees. Reviewing client charts to ensure compliance with...
Permanent employment
Full time
Seasonal work
Immediate start
SeaMar Community Health Centers
Burien, WA
3 days ago
Clinical Supervisor - Salary
$80.17k
...medical, dental, and behavioral health clinics and a wide variety of nutritional, social... ...coordinates with the Behavioral Health Program Manager regarding administrative and clinical... ...directing work/caseloads for employees. Reviewing client charts to ensure compliance with...
Permanent employment
Full time
Seasonal work
Immediate start
SeaMar Community Health Centers
Seattle, WA
1 day ago
Clinical Supervisor
$60k - $65k
...Responsibilities Assists in leading the clinical team daily, providing a model of positive... ...and procedures. Collaborate with Management to support development of training strategies... ...reinforcing customer service standards, reviewing performance metrics, and promoting a strong...
Work at office
Flexible hours
Advantia Health
Seattle, WA
1 day ago
Hospital Manager
$80.2k - $90k
...Client Service professional to join our leadership team as Hospital Manager. The role demands a leader with the interpersonal and... ...efficient and profitable hospital operations. Oversee the hiring, reviewing, disciplining and terminating of professional staff, in accordance...
Work from home
Home office
VCA Animal Hospitals
Seattle, WA
3 days ago
Clinical Supervisor - Salary
...medical, dental, and behavioral health clinics and a wide variety of nutritional, social... ...individual and group counseling, milieu management, and supervision of patients. These adults... ....* Provides case consultation, file reviews, treatment plan reviews of counselors and...
Contract work
Work at office
Local area
Seamar
Seattle, WA
2 days ago
Hospice Clinical Manager
$85k - $115k
...Hospice Clinical Manager (RN) Full‑time position located in Tacoma, Pierce County, Washington. Salary: $85,000–$115,000 annually, DOE. Total... ...with all state/federal hospice laws and regulations. Review all incoming referrals for appropriateness and manage approvals...
Full time
Flexible hours
Deercreekseniorliving
Seattle, WA
3 days ago
Associate Medical Director Behavioral Health or Utilization Management Medical Director DOE
$217.6k - $294.4k
...Director Behavioral Health Or Utilization Management Medical Director Doe This is a part-... ...Directors provides leadership, and clinical oversight for behavioral health operations... ...strategies related to our members. Conducts case reviews requiring physician involvement and/or...
Part time
Immediate start
Work from home
Flexible hours
Cambia Health Solutions
Bellevue, WA
17 hours ago
Manager, Clinical Science, Medical Affairs
$150k - $170k
...Are you ready to accelerate your potential and make a real difference within life sciences, diagnostics and biotechnology? The Manager, Clinical Science, Medical Affairs is a critical strategic role that drives sustainable business value by ensuring scientific...
Integrated DNA Technologies
Seattle, WA
4 days ago
Clinic Director
$101.24k - $126.55k
...Overview Lead with Purpose as a Clinic Director at ATI Physical Therapy! Are you a licensed... ...: Our clinics boast a 4.9/5 Google Review Rating across locations, reflecting our... ...time with our proprietary EMR and Patient Management Tool, designed by therapists for therapists...
Full time
Temporary work
Local area
Flexible hours
ATI Health
Mountlake Terrace, WA
3 days ago
Associate Medical Director - Post Acute Care
$179.5k - $307.73k
...Post Acute Care Sign on bonus: $10,000 Clinical Operations Associate Medical Director Carelon Medical Benefits Management Post Acute Care Benefit Utilization Management... ...Ensures timely completion of clinical case reviews for their board certified specialty....
Full time
Temporary work
Part time
Work experience placement
Local area
Relocation package
Shift work
Weekend work
1 day per week
Elevance Health
Seattle, WA
4 days ago
Clinical Manager
...nonprofit status HOW YOU WILL MAKE AN IMPACT: The Clinical Manager will oversee day-to-day operations of the WISe program including... ...casework and professional issues of employees to include, review and assess client progress notes, mental health assessments and...
Hourly pay
Contract work
Temporary work
Work at office
Local area
Lutheran Community Services Northwest
Seattle, WA
20 hours ago
Utilization Management Medical Director - Medical Oncology - Remote anywhere in US 2358557 | Houston, TX | Remote
$248.5k - $373k
...Connecting. Growing together. The Medical Director Oncology will provide utilization review determinations and support case and disease management teams to achieve optimal clinical outcomes. You'll enjoy the flexibility to work remotely from anywhere within the U.S...
Remote job
Minimum wage
Work experience placement
Local area
UnitedHealthcare At Home
Seattle, WA
3 days ago
Senior Medical Director
$250k - $313k
...Cure. Position Summary The Medical Director will serve as a clinical leader, providing medical and scientific expertise to support... ...site and investigator engagement, medical monitoring, and data review. Engage with global regulatory agencies to support program...
2 days per week
Umoja Biopharma
Seattle, WA
2 days ago
Clinic Director - IRG Mountlake Terrace
$86.5k - $100k
...Clinic Director IRG Physical & Hand Therapy is the premier provider of outpatient Physical... .... This position provides leadership, management, supervision, patient care and... ...with company set benchmarks and goals. Review weekly flash reports, monthly insights reports...
Work at office
Immediate start
Flexible hours
IRG Physical and Hand Therapy
Mountlake Terrace, WA
3 days ago

Do you want to receive more vacancies?

Subscribe and receive similar vacancies to Manager Clinical Review - FEP. Be the first to apply!