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The Role

We are seeking a dynamic leader to join our team as the Manager, Clinical Review. This role directs the utilization review clinical team operations for our Commercial plans. The manager will lead a clinical team, foster a culture of excellence, and ensure delivery of medically necessary, high-quality, and cost-effective care. This position is accountable for maintaining rigorous compliance with all regulatory and accreditation standards while driving strategic initiatives to improve member outcomes.

Key Responsibilities

Strategic & Team Leadership

+ Provide decisive leadership and direct supervision to a clinical staff team.

+ Execute a forward-thinking utilization management strategy that aligns with the company's goals.

+ Lead performance management, including hiring, professional development, mentorship, and performance evaluations to build a hig...