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.

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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.