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 an