As Clinical Manager, Medical Bill Review & Product Development, you will be an essential member of the workers’ comp managed care and cost containment team. You’ll be responsible for daily operations of clinical medical bill review services, developing and implementing new productsand programs to improve patient outcomes and drive business success. The ideal candidate for this position will have strong clinical nursing acumen, managed care operations, as well as a managed care product development background, excellent communication skills, leadership experience, and a strategic mindset. The candidate will have comprehensive understanding of workers’ comp regulatory compliance and medical billing procedures, and they will be able to work closely with the IT team, claims professionals, patients, and other stakeholders to ensure the proper execution of necessary protocols. They will also possess excellent organizational skills, attention to detail, and strong analytical abilities to review medical bills, identify discrepancies, and provide feedback to the billing department. - Management and coordination of clinical medical bill review operations, ensuring proper documentation, coding, and program effectiveness - Develop and document clinical protocols, conduct clinical studies, and ensure compliance with regulatory requirements - Provide education and training to clinical/medical bill review teams and external stakeholders - Be the subject matter expert of nurse and code review products - Coordinate with cross-functional teams to develop rules and other technical automation - Work closely with IT and OU (client) teams to ensure successful product launches and promote product adoption among target audiences - Implement and evaluate product development enhancements and outcome metrics - Collaborate with physicians, pharmacists, and other healthcare professionals to ensure the integration of clinical knowledge into product development - Monitor emerging trends in the healthcare industry and provide recommendations for product development based on market analysis and product performance data - Conduct market research to identify new opportunities for product development within the managed care industry - Provide timely coaching and feedback to drive and manage individual and team performance - Assess talent, identify employee development and training needs, and collaborate with HR partner, leadership and team members to establish goals and create development plans - Partner with HR and senior leadership to execute talent management strategies to improve employee engagement, job satisfaction, and foster a psychologically safe work environment  

As a Project Manager, you will manage key IT projects to meet customer needs and organizational goals. You will be responsible for the coordination and completion of projects on time within budget and within scope. You’ll oversee all aspects of projects, set deadlines, assign responsibilities, and monitor and summarize progress for senior leadership.    Key functions include but are not limited to:   - Leads and demonstrates value added principles to the team - Coordinate internal resources and third parties/vendors for the flawless execution of projects - Establishes, communicates and executes assigned project plans that drive toward project goals/milestones through to completion - Assist in the definition of project scope and objectives, involving all relevant stakeholders and ensuring technical feasibility - Ensure resource availability and allocation - Manage changes to the project scope, project schedule and project costs using appropriate verification techniques - Continuously monitors and notes risks and issues as they arise and elevates them to management. - Perform risk management to minimize project risks - Ensures Agile/Scrum concepts and principles are adhered to, and is the voice of reason and authority making tough calls - Facilitates discussion and alternatives or different approaches - Brings disclosure and transparency to the business about development and grows trust - Continually grows their craft learning new tools and techniques to manage themselves and a team - Facilitates and documents all scrum meetings including daily stand up meetings, sprint planning and backlog grooming - Supports the product owner and business analyst in backlog management and maintenance. - Documents / Grooms the backlog - Drives the sprint and release planning