Clinical Operations Manager - Remote

Overview

Gravie is seeking an experienced Clinical Operations Manager to lead the development and implementation of clinical policies and strategies within our health plan, ensuring alignment with industry standards and optimizing member care.

In Short

• Serve as a strategic clinical leader bridging clinical teams and health plan operations.
• Lead design and implementation of clinical protocols and policies.
• Monitor and evaluate options for member benefits.
• Oversee policy development and standardization.
• Provide guidance on medical necessity reviews and claims evaluations.
• Partner with vendors to enhance accuracy and reduce errors.
• Support fraud detection efforts and develop mitigation policies.
• Identify cost containment strategies using data analytics.
• Influence plan language for clarity and member satisfaction.
• Act as a trusted clinical advisor across the organization.

Requirements

• Bachelor’s degree in Nursing; Master’s preferred.
• Active RN or NP license in the state hired.
• 10+ years of nursing experience focused on health plan operations.
• 3+ years in a leadership role within a health plan or managed care organization.
• Expertise in medical policy development and regulatory compliance.
• Experience in cost containment and claims analysis.
• Exceptional communication and leadership skills.
• Strong analytical mindset for strategic decision-making.
• Ability to work independently and manage multiple priorities.
• Demonstrated customer service and organizational skills.

Benefits

• Flexible PTO and paid parental leave.
• Standard health and wellness benefits.
• 401k program and education reimbursement.
• Cell phone reimbursement and transportation perks.
• 1 week of paid paw-ternity leave.