Manager, Clinical Programs - Premera Blue Cross

**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. To better serve our customers, we're creating a culture that promotes employee growth, collaborative innovation, and inspired leadership. We are committed to creating an environment where employees can do their best work and where best-in-class talent comes, stays, and thrives! As a result of these efforts we are proud to share that Forbes ranked Premera among America's 2023 Best Midsize Employers (https://www.forbes.com/lists/best-midsize-employers/?sh=58210f5e210f) and America's 2023 Best Employers By State (https://www.forbes.com/lists/best-employers-by-state/?sh=21c7c3d1983b) . Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog: https://healthsource.premera.com . **The Manager, Case Management Team** is a Supervisor for Case Managers. This position is responsible for the execution and implementation of Clinical Programs' strategy and goals and the oversight of Clinical Programs' operations. The incumbent oversees the effective integration and continuous improvement of processes and systems to meet Premera's current and future business goals. Responsibilities also include managing and developing a team of clinical and support staff promoting their professional growth and operational effectiveness. **What you'll do:** + Participate in development of Clinical Programs' strategy and planning in accordance with company's mission and strategic goals, federal and state law and regulations, and accreditation standards. + Assist in the selection, training, evaluation, and development of professional paraprofessional, and administrative team members. + Lead Care Management teams in effective performance of job functions, which may include preauthorization, outpatient and inpatient management, case management, retrospective claim review, and delegated management oversight. + Participate in the development and monitoring of budgets in accordance with department and organizational objectives. + Assist with the adjustment and direction of work processes to support cost and utilization variations. + Participate in the development, implementation, and monitoring of the department's performance standards, utilizing quality improvement methodologies to refine procedures. + Participate in the establishment and implementation of Care Management policies as required. + Foster collaborative work environment that encourages team building, facilitates cohesive synergetic performance of Care Management functions, while valuing the individual diversity and uniqueness of all employees. + Build and maintain cooperative business relationships. + Participate in Total Quality Management activities and processes to assure operational compliance with regulatory requirements, including NCQA, NEMIS, HCFA, and OIC. + Ensure team members that can articulate the expectations of performances are invested in productivity and customer service, and can describe a positive feeling about the work environment. + Effectively manages deficits with improvement plans and consistent follow-up. + As part of this role, you may be assigned internal controls derived from Premera's internal controls framework. You will be accountable for understanding the controls assigned to you, their impacts on Premera, and to ensure that they are operating effectively. **What You'll Bring:** + Candidates with a RN License are highly preferred. + For nursing, Associate's Degree in Nursing; or Bachelor's degree in Nursing; for behavioral health, Master's degree in Social Work, Marriage and Family Therapy, Mental Health Counseling, or related degree. **(Required)** + Current state credential (e.g. licensure) that allows the professional to conduct an assessment independently as permitted within the discipline's scope of practice:- For nurses, required registration (e.g. RN, ARNP).- For behavioral health, required licensure (e.g. LMFT, LICSW, LPC, LMHC)- For psychologist, required board certification- For dietitians, required certification as a nutritionist or dietician.- Or licensure in related healthcare discipline. **(Required)** + Certified in CCM (Certified Case Management) or obtain certification within 24 months of date of hire. **(Required)** + Five (5) years case management or health care experience. **(Required)** + Three (3) years management experience. **(Required)** + Advanced degree such as Master's Degree in a Health-Related field preferred. + Experience with NCQA, URAC, or accreditation review processes + Experience in continuous process improvement and creative problem solving (e.g. LEAN, Synectic) + Advanced training in Motivational Interviewing + Experience training clinical and non-clinical staff + Experience managing case management teams and integrated case management model \#LI - RS1 \#GD **What we offer** + Medical, vision and dental coverage + Life and disability insurance + Retirement programs (401K employer match and pension plan) + Wellness incentives, onsite services, a discount program and more + Tuition assistance for undergraduate and graduate degrees + Generous Paid Time Off to reenergize + Free parking **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. **National Salary Range:** $84,800.00 - $144,200.00 **National Plus Salary Range:** $96,700.00 - $164,400.00 _*National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska_ _._ At Premera, we make healthcare work better. By focusing on improving our customers' experience purposefully and serving their needs passionately, we make the process easier, less costly, and more positive. Through empathy and advocacy, we change lives. As the leading health plan in the Pacific Northwest, we provide comprehensive health benefits and services to more than 2 million customers, from individuals to Fortune 100 companies. Our services include innovative programs focused on health management, wellness, prevention, and patient safety. We deliver these programs through health, life, vision, dental, disability, and other related products and services. Premera Blue Cross is headquartered in Mountlake Terrace, WA, with operations in Spokane and Anchorage. The company has operated in Washington since 1933 and in Alaska since 1952. With more than 80 years of experience in the region, we deliver innovation, choice, and expertise.