Remote Clinical Manager, Care Management & Utilization

Intermountain Healthcare Inc.; Columbia (SC); On-site; USD 62,000 - 95,000; Full time

Job summary

Intermountain Health is seeking a Clinical Manager for Select Health - Murray to lead Utilization Review and Care Management teams in a managed care setting. You will drive high-quality, cost-effective care, ensure regulatory compliance, and collaborate with nursing leaders, physicians, and payers to optimize member outcomes.

The role requires NCQA/CMS compliance, clinical leadership, and program development experience, with a focus on performance metrics and staff development.

Qualifications

• Bachelor’s degree in Nursing or Master’s in Clinical Social Work.
• Current licensure with compact privileges; must transfer licenses within 60 days.
• Leadership or supervisory experience in clinical or managed care settings.
• Two years of clinical experience and one year in care management or utilization review.
• Strong written and verbal communication skills.
• Intermediate computer skills and ability to troubleshoot independently.
• Leadership training completed within one year of accepting the position.

Responsibilities

• Lead Restriction Team (Medicaid Lock-in).
• Lead, supervise, and mentor RN/Behavioral Health Care Managers and UR clinicians.
• Oversee daily operations, staffing, resources, and workflow.
• Manage departmental budgets and evaluations.
• Develop and monitor UR/Care Management program structure and outcomes.
• Facilitate collaboration among members, providers, and payers.
• Ensure regulatory compliance (NCQA, CMS, Joint Commission).
• Drive continuous improvement and address gaps.
• Coordinate safe transitions of care and discharge planning.
• Create and present program performance reports.

Skills

Leadership

Communication

Utilization review Experience

Care management Experience

Team Performance management

Financial acumen

Clinical knowledge

Problem-solving

Education

Bachelor’s degree in Nursing (BSN) or Masters in Clinical Social Work (LCSW)

Tools

Compact licensure transfer within 60 days

Job description

Intermountain Health is seeking a Clinical Manager for Select Health - Murray to lead Utilization Review and Care Management teams in a managed care setting. You will drive high-quality, cost-effective care, ensure regulatory compliance, and collaborate with nursing leaders, physicians, and payers to optimize member outcomes.

The role requires NCQA/CMS compliance, clinical leadership, and program development experience, with a focus on performance metrics and staff development.