Facilitates Utilization Management and Care Management Oversight Committee meetings and participates in Stakeholder Oversight Committee meetings to deliver UM and CM performance reporting.
Facilitates working sessions with stakeholders to resolve program and process challenges.
Identifies barriers to vendor or program performance and partners with internal teams and vendors to address and resolve issues.
Implements a quarterly vendor performance program for Utilization Management and Care Management programs, serving as the primary operational point of contact.
Monitors vendor adherence to Service Level Agreements (SLAs), Key Performance Indicators (KPIs), and contractual requirements and supports timely resolution of issues/complaints.
Prepares summaries of program performance, risks, and operational recommendations for leadership.
Reviews and analyzes internal and vendor program data to identify performance trends, risks, and improvement opportunities.
Certifications
Registered Nurse (RN) - Arkansas State Board of Nursing
Security Requirements
Segregation of Duties
Segregation of duties will be used to ensure that errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business. This position must adhere to the segregation of duties guidelines in the Administrative Manual.
Employment Type
Regular
ADA Requirements
1.1 General Office Worker, Sedentary, Campus Travel - someone who normally works in an office setting or remotely and routinely travels for work within walking distance of location of primary work assignment.
Requirements
EDUCATION
Bachelor's degree in healthcare administration, public health, social work or related field required.
Master's degree in nursing preferred.
LICENSING/CERTIFICATION
Clinical licensure such as Registered Nurse (RN), Licensed Practice Nurse (LPN), and/or Social Work (SW) preferred.
Minimum of two (2) years demonstrated experience in reporting or dashboarding for program management to track key performance indicators.
Experience managing or working with external vendors preferred.
Strong knowledge of Utilization Management or Care Management workflows, documentation standards, and care coordination processes.
ESSENTIAL ABILITIES
Demonstrated critical thinking and sound judgment.
Ability to interpret performance data, identify trends, and develop actionable recommendations.
Ability to lead requirements development and collaborate with data team to develop reporting and dashboarding for program monitoring.
Business Process Development
Critical Thinking
Cross-Functional Collaboration
Data Reporting
Documentations
Facilitation
Interpersonal Communication
Leadership
Microsoft Office
Organizational Compliance
Organizing
Prioritization
Relationship Management
Setting Performance Standards
Benefits
Health insuranceRemote work options
Additional Information
To learn more about Arkansas Blue Cross and Blue Shield Hiring Policies, please click here .
Job Summary
The Manager of Clinical Program Management and Vendor Performance will compile reporting related to the performance and continuous improvement of Utilization Management (UM), Care Management (CM) and vendor programs. This role collaborates across clinical, operational and analytic teams for all lines of business to ensure compliant and high quality member centered outcomes. The Manager supports program monitoring, reporting, vendor performance management, and execution of internal operational improvements and vendor oversight for compliance requirements.
Arkbluecross · Arkansas Remote