Clinical Program Manager – Care Optimization & Compliance

Martin's Point Health Care Inc.

Portland (ME)

Hybrid

USD 115,000 - 142,000

Full time

14 days+

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Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Retirement contributions

Job summary

Martin's Point Health Care in Maine is seeking a Clinical Program Manager - Case Management to lead strategic initiatives for Generations Advantage and US Family Health Plan, designing and overseeing programs to improve care transitions and reduce readmissions. The role collaborates with cross-functional teams, ensures regulatory compliance, and refines workflows and dashboards to optimize performance.

The ideal candidate brings 10+ years of healthcare program management, CCM/ACMA certification

Qualifications

Bachelor’s degree in Health Science, Nursing or related field required.
Master’s degree in Business Administration (MBA), Healthcare Administration (MHA), or Public Health (MPH) preferred.
Certified Case Manager (CCM) or American Case Management Association (ACMA) certification preferred.
10 years’ experience in healthcare including managed care, with a focus in Program Management, overseeing clinical programs and driving process improvement initiatives required.
Experience using data and data analysis to design and monitor programs and manage success, including ROI, of programs required.
Experience in evaluating financial and clinical performance metrics required.
Experience in Medicare Advantage and TRICARE preferred.
Knowledge of NCQA case management accreditation standards, audit preparations, and HEDIS quality metrics required.
Excellent communication and presentation skills, oral and written.
Strong organizational skills including the ability to work independently and prioritize work.
Proficiency with Microsoft Excel, Visio, Word, PowerPoint, Outlook, Access.

Responsibilities

Supports program development activities, including operational reporting and program resources.
Translates organizational strategy into actionable, localized case management work plans.
Streamlines case management workflows to eliminate clinical inefficiencies and improve member engagement.
Optimizes data reporting structures to track program metrics, identifying trends that require clinical interventions.
Monitors program benchmarks and KPIs to measure the success of CM Program.
Ensures all clinical initiatives comply with TriCare, CMS, NCQA, and other standards.
Identifies trends, gaps and operational risks through performance monitoring.
Develops presentations, communication, and program tools in support of CM Program.
Partners with cross-functional leaders to align care model and implement new program initiatives.
Facilitates committees and working groups to communicate program updates, barriers, and financial outcomes.
Collaborates with IT and analytics teams to refine case management software platforms and reporting dashboards and scorecards.