Manager Clinical Review – FEP

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: https://healthsource.premera.com/.

The 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 careers@premera.com or via phone at 425-918-4785.

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.