Clinical Operations Manager

5 days ago


Baltimore, Maryland, United States MEDSTAR HEALTH Full time

MedStar Health is seeking a highly skilled Clinical Operations Manager to lead our Case Management Department. This role will be responsible for overseeing the day-to-day operations of the department, including managing coverage assignments, reviewing and processing time-off requests, and updating staffing calendars.

About the Role

We are looking for an experienced professional with a strong background in case management and leadership. The ideal candidate will have 5-7 years of diverse clinical experience and at least 3 years of experience in utilization management or case management.

Key Responsibilities
  • Assist hospital discharge planners and other referral sources with discharge planning
  • Act as a liaison to MedStar Family Choice contracted vendors to facilitate care
  • Identify gaps in contracted services and develop a plan to access care
  • Authorize and monitor covered services according to policy
  • Process pre-authorizations for medical necessity, LOC, covered benefits, and participation of the provider
  • Perform telephonic inpatient utilization review services
  • Run productivity reports, collaborate with the manager to analyze reports, and schedule regular meetings with associates to review reports and progress toward goals
Requirements

To be successful in this role, you must have:

  • An Associate's degree in Nursing (BSN preferred)
  • A valid RN license in Maryland, Virginia, District of Columbia (or any combination as required based on work location(s))
  • Certified Case Manager (CCM) certification (preferred)
  • Excellent interpersonal skills
  • Ability to use computer to enter and retrieve data
  • Working knowledge of Microsoft Word, Excel, and PowerPoint applications
Salary and Benefits

The salary for this role is $85,000 - $110,000 per year, depending on experience. MedStar Health offers a comprehensive benefits package, including health, dental, and vision insurance, retirement savings plan, paid time off, and more.

About Us

MedStar Health is a not-for-profit health system based in the Washington, D.C. metropolitan area. We are dedicated to providing high-quality, patient-centered care to our communities. If you are passionate about delivering exceptional healthcare and leading teams to achieve excellence, we encourage you to apply for this exciting opportunity.



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