Manager Specialty Care Management

Job Description

The Clinical Manager at Select Health leads and supervises a team of Utilization Review and Care Management clinicians within an insurance and managed care environment. This role ensures delivery of high-quality, cost-effective care management services, compliance with regulatory requirements, and achievement of organizational financial and clinical objectives. The Clinical Manager collaborates with nursing leaders, physicians, and other stakeholders to optimize member outcomes, drive program innovation, and foster professional development within the team.

The Clinical Manager at Select Health leads and supervises a team of Utilization Review and Care Management clinicians within an insurance and managed care environment. This role ensures delivery of high-quality, cost-effective care management services, compliance with regulatory requirements, and achievement of organizational financial and clinical objectives. The Clinical Manager collaborates with nursing leaders, physicians, and other stakeholders to optimize member outcomes, drive program innovation, and foster professional development within the team.

• Lead Restriction Team (sometimes referred to as Medicaid Lock-in)
• Lead, supervise, and mentor a team of RN or Behavioral Health Care Managers and RN or Behavioral Health Utilization Review clinicians, and related support positions ensuring clinical excellence and regulatory compliance.
• Oversee daily operations, including staffing, resource allocation, and workflow optimization.
• Manage departmental budgets and performance evaluations, ensuring financial stewardship and achievement of organizational goals.
• Develop, implement, and monitor program structure, processes, and outcome standards for Utilization Review and Care Management.
• Facilitate interdisciplinary collaboration and communication among members, families, providers, and payers.
• Ensure compliance with regulatory bodies (NCQA, CMS, Joint Commission) and patient safety initiatives.
• Champion continuous improvement, address gaps, and monitor internal processes and metrics.
• Coordinate safe transitions of care, including discharge planning and repatriation to participating providers.
• Create and present reports on program performance, including outcome measures and return on investment.
• Support staff development, mentorship, and participation in community outreach activities.

• Leadership
• Communication
• Utilization review Experience
• Care management Experience
• Team Performance management
• Financial acumen
• Clinical knowledge
• Problem-solving

• Bachelor’s degree in Nursing (BSN) from an accredited institution or Masters Degree in Clinical Social Work (LCSW)
• Current licensure with compact privileges; must transfer licenses within 60 days.
• Leadership or supervisory experience in clinical or managed care settings.
• Two years of clinical experience and one year in care management or utilization review.
• Strong written and verbal communication skills.
• Intermediate computer skills and ability to troubleshoot independently.
• Completion of required leadership training within one year of accepting the position.

• Master’s degree in a clinical, education, or business specialty.
• Specialty certification in care management or utilization review.
• Experience in program development and oversight.
• Project management and organizational skills.

• Ability to read and assess information, documents, and monitors.
• Frequent verbal communication and hearing for interactions with colleagues and providers.
• Manual dexterity for computer use and equipment handling.
• May be required to sit or stand for extended periods.
• For roles requiring driving: ability to drive and read signs,…