Senior Manager Clinical Review - LH

At Luminare Health, our people are what set us apart. Their expertise, dedication, and passion for service excellence are the foundation of our success.
We're committed to helping our employees grow through thoughtful development opportunities, meaningful work, and a culture that values collaboration and continuous improvement. When you join Luminare Health, you join a purpose-driven team focused on making healthcare simpler, better, and more affordable.
Job Summary
The Senior Manager, Clinical Review is responsible for the daily operations of Clinical Review Department in Healthcare Management in collaboration with the Associate Director, including oversight and accountability for the assigned staff performing the Utilization Management and Claims Medical Management functions and support work for the Utilization Review Program. Also conducts analysis of data as it relates to the Healthcare Management processes and outcomes, determines trends, staffing needs and risks to improve the overall effectiveness and efficiency of the department.
Remote employees must live within the continental United States, excluding Alaska, New York, California, or Hawaii.
Required Job Qualifications
Bachelor's Degree
Active state Registered Nurse license in good standing
7 years' experience in direct clinical care or managed care
3 years of management experience
Prior Utilization Management experience
Communicate in a positive and effective manner in both oral and written communication
Read and interpret documents, criteria, instructions, and policy & procedure manuals
Write/create routine correspondence and reports
Speak effectively with co-workers and senior management
Ability to successfully train adult learners and meet the educational needs of those being trained
Critical thinking skills allowing one to apply common sense to carry out instruction furnished in written, oral or diagram form
Must be able to multi-task in an environment that requires organization and prioritization and the ability to address time sensitive assignments
Maintain a high level of confidentiality, flexibility and willingness to learn new tasks and take on new duties as needed
Work in a dynamic team-oriented environment
Work independently with minimal supervision or instruction.
Demonstrates knowledge of Microsoft Office Suite products.
Preferred Job Qualifications
Bachelor of Science in Nursing
Prior supervisory or leadership experience
Clinical Case Manager (CCM) Certification
Remote employees must live within the continental United States, excluding Alaska, New York, California, or Hawaii.
Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!
EEO Statement
We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.
Pay Transparency Statement
At Luminare, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for associates.
The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.
Min To Max Range
$67,600.00 - $127,000.00
Exact compensation may vary based on skills, experience, and location.

Work arrangement
No