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Manager, Clinical Cost Containment

2 hours, 1 minute ago
United States
Full-time
Mid Level
Operations Manager
Data Science and Analytics
Apply Now
Healthcare Management Administrators

Healthcare Management Administrators

Healthcare Management Administrators is a specialized third-party administrator that provides high-quality, innovative, and affordable health plans for self-funded employers, emphasizing exceptional service and a collaborative partnership model.

Insurance
251-1K
Founded 1986
View All Jobs 2

Description

  • Lead the execution, optimization, and evolution of clinical cost containment initiatives, including coding policy review, medical necessity review, and fraud, waste, and abuse identification.
  • Translate organizational and client objectives into program goals, success metrics, and operating plans tied to revenue, savings, and operational performance.
  • Ensure clinical review programs align with plan documents, clinical guidelines, regulatory requirements, and service-level expectations.
  • Oversee timely and accurate clinical reviews that support claims adjudication workflows and minimize operational disruption.
  • Partner with Claims Operations to balance payment accuracy, turnaround time, and member/provider experience.
  • Identify operational risks, bottlenecks, and opportunities for automation or workflow improvement.
  • Evaluate program outcomes and track savings, recoveries, cost avoidance, and revenue opportunities.
  • Lead performance and quality improvement efforts, including root-cause analysis and corrective action planning.
  • Lead, mentor, and develop a multidisciplinary team of coders, nurses, and analysts.
  • Partner with employer groups, stop-loss carriers, finance, analytics, claims, and care management leaders, including client-facing discussions about performance and roadmap planning.

Requirements

  • Bachelor's degree or equivalent in a related field required.
  • 3-5+ years of leadership experience in healthcare, insurance, revenue cycle, payment integrity, or cost-containment industries.
  • Strong understanding of healthcare claims coding, including CPT, HCPCS, and ICD-10.
  • Experience with claims adjudication and how coding affects reimbursement.
  • Excellent technical and organizational skills with a proven track record of delivering operational initiatives end to end.
  • Strong data analysis skills and the ability to make data-driven business recommendations quickly.
  • Demonstrated experience building program growth strategies and medium- to long-term roadmaps.
  • Ability to communicate effectively and influence direct reports, colleagues, and executives.
  • Expert problem-solving, organizational, and relationship-building skills.
  • Experience collaborating with diverse stakeholders and leading, developing, motivating, and holding others accountable.
  • Proficiency with MS Office Suite, including advanced PowerPoint skills.

Benefits

  • Base salary range of $110,000-$140,000 in the greater Seattle area, depending on geography, skills, experience, education, and other factors.
  • Performance-based incentive bonus opportunities.
  • Seventeen days of paid time off for individual contributors.
  • Eleven paid holidays, plus two paid personal days and one paid volunteer day.
  • Company-subsidized medical, dental, vision, and prescription insurance.
  • Company-paid disability, life, and AD&D insurance, plus voluntary insurance options.
  • 401(k) retirement plan with company match.
  • Annual $500 wellness incentive and $600 wellness reimbursement.
  • Remote work options and continuing education reimbursements.
  • Parental leave and up to $1,000 annual charitable giving match.
  • Flexible schedules supporting work-life balance, plus access to a renovated office with free parking and a gym.

Interested in this position?

Apply directly on the company website

Apply Now

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