Senior Manager Clinical Programs (Case Management)

Premera Blue Cross; United States; Remote; USD 95,000 - 163,000; Full time

Job summary

A leading health plan provider is seeking a Senior Manager for Clinical Programs, responsible for operational strategy and management. The role emphasizes team development, regulatory compliance, and continuous process improvement. Candidates should have a relevant degree, a nursing license, and substantial health plan industry experience. This remote position offers competitive salaries and benefits.

Benefits

Medical, vision, and dental coverage

401K employer match

Wellness incentives

Generous paid time off

Tuition assistance

Qualifications

• 7+ years of health plan industry experience.
• 5+ years progressive management experience.
• Certified in CCM (Certified Case Management) or obtain certification within 24 months.

Responsibilities

• Develop Clinical Program strategy in line with company goals.
• Manage and develop clinical programs teams.
• Represent clinical priorities with internal and external stakeholders.

Skills

Healthcare management

Leadership

Regulatory compliance

Clinical Program management

Continuous Process Improvement

Education

Bachelor's Degree in a healthcare-related field

Licensed registered nurse

Tools

Data analysis tools

Job description

Workforce Classification:

Telecommuter

Join Our Team: Do Meaningful Work and Improve People’s Lives

Our purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.

To better serve our customers, we are fostering a culture that emphasizes employee growth, collaborative innovation, and inspired leadership. We are dedicated to creating an environment where employees can excel and where top talent is attracted, retained, and thrives. As a testament to these efforts, Premera has been recognized on the 2025 America's Dream Employers (https://www.forbes.com/lists/americas-dream-employers/) list. Newsweek honored Premera as one of America's Greatest Workplaces (https://www.newsweek.com/rankings/americas-greatest-workplaces-2024) , America's Greatest Workplaces for Inclusion (https://rankings.newsweek.com/americas-greatest-workplaces-diversity-2025) , and America's Greatest Workplaces For Mental Well-Being (https://rankings.newsweek.com/americas-greatest-workplaces-for-mental-well-being-2025) , Forbes ranked Premera among America’s Best Midsize Employers (https://www.forbes.com/lists/best-midsize-employers/?sh=58210f5e210f) for the fourth time.

Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog: https://healthsource.premera.com/ .

As a Senior Manager, Clinical Programs (Case Management) , you will be responsible for operations and the execution and implementation of strategy and goals related to Clinical Programs. In addition, you will be accountable for ensuring effective integration and continuous improvement of processes and systems to meet Premera's current and future business needs and goals. Functional and budgetary areas of accountability include one or more of the following: personal health support services including dedicated teams, engagement team, and/or support services.

This is a virtual/telecommuter position, working from home.

What you’ll do:

• Participate in the development of Clinical Program’s strategy and plan in accordance with company's mission and strategic goals, federal and state law and regulations, and accreditation standards.

• Attract, manage, and develop clinical programs teams and promote staff development to support professional growth and operational effectiveness. Provide timely feedback and coaching to employees to ensure continuous development to meet current and future needs of the business.

• Represent department, programs, and clinical priorities with internal executive management and key external stakeholders.

• Lead the planning of resources and systems to support implementation of Premera's clinical program strategy and operations.

• Oversee the development and ongoing measurement of operational metrics and reports.

• Coordinate work effort with Director of Clinical Programs and colleagues of multiple teams to achieve organizational efficiency and effectiveness.

• Collect, analyze, maintain, and report data on high-risk members, contractual requirements, performance guarantees, outcome measures, resource utilization, and operational metrics.

• Act as the liaison to third party organizations that support Premera's Clinical Program activities ensuring integration between programs.

• Lead and maintain a culture of continuous improvement that positively contributes to the achievement of Premera's goals.

• Lend clinical and business expertise to support business needs.

• Develop and manage department budget(s).

• Lead, support, or participate on special projects, committees or task forces as assigned.

What you’ll bring:

• Bachelor's Degree in a business or healthcare related field or (4) years of experience in one of those areas. (Required) Bachelor’s Degree in nursing or Master’s Degree in behavioral health services preferred.

• Current Washington or Multistate/Compact licensed registered nurse, or licensed mental health professional. (Required)

• (7) years of health plan industry experience or business/operational experience. (Required)

• (5) years of progressive management experience including experience managing multifunctional teams in multiple locations. (Required)

• Certified in CCM (Certified Case Management) or obtain certification within 24 months of date of hire. (Required)

• Experience managing Clinical Program (Case Management) teams is preferred.

• Advanced degree e.g., MBA, MHA, or other Master's Degree preferred.

• Experience with Blue Cross and/or Blue Shield plans.

• Experience in Continuous Process Improvement (e.g., Lean or Six Sigma).

• Knowledge of federal and state regulatory or accreditation requirements (e.g., HIPAA, NCQA).

• Solid background and understanding of health care services and management.

Premera total rewards

Our comprehensive total rewards package provides support, resources, and opportunities to help employees thrive and grow. Our total rewards are more than a collection of perks, they're a reflection of our commitment to your health and well-being. We offer a broad array of rewards including physical, financial, emotional, and community benefits, including:

• Medical, vision, and dental coverage with low employee premiums.

• Voluntary benefit offerings, including pet insurance for paw parents.

• Life and disability insurance.

• Retirement programs, including a 401K employer match and, believe it or not, a pension plan that is vested after 3 years of service.

• Wellness incentives with a wide range of mental well-being resources for you and your dependents, including counseling services, stress management programs, and mindfulness programs, just to name a few.

• Generous paid time off to reenergize.

• Looking for continuing education? We have tuition assistance for both undergraduate and graduate degrees.

• Employee recognition program to celebrate anniversaries, team accomplishments, and more.

For our hybrid employees, our on-campus model provides flexibility to create your own routine with access to on-site resources, networking opportunities, and team engagement.

• Commuter perks make your trip to work less impactful on the environment and your wallet.

• Free convenient on-site parking.

• Subsidized on-campus cafes make lunchtime connections with colleagues fun and affordable.

• Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more.

• Our complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling.

• Need a brain break? Challenge someone to a game of shuffleboard or ping pong while on campus.

Equal employment opportunity/affirmative action:

Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.

If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at [e-mail] or via phone at 425-918-4785.

Premera is hiring in the following states, with some limitations based on role or city: Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, Wisconsin .

The pay for this role will vary based on a range of factors including, but not limited to, a candidate’s geographic location, market conditions, and specific skills and experience.

The salary range for this role is posted below; we generally target up to and around the midpoint of the range.

National Salary Range:

$95,600.00 - $162,500.00

National Plus Salary Range:

$109,000.00 - $185,300.00

*National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska .

We’re happy to discuss compensation further during the interview because we believe that open communication leads to better outcomes for all. We’re committed to creating an environment where all employees are celebrated for their unique skills and contributions.

At Premera, we make healthcare work better. By focusing on improving our customers’ experience purposefully and serving their needs passionately, we make the process easier, less costly, and more positive. Through empathy and advocacy, we change lives.

As the leading health plan in the Pacific Northwest, we provide comprehensive health benefits and services to more than 2 million customers, from individuals to Fortune 100 companies. Our services include innovative programs focused on health management, wellness, prevention, and patient safety. We deliver these programs through health, life, vision, dental, disability, and other related products and services.

Premera Blue Cross is headquartered in Mountlake Terrace, WA, with operations in Spokane and Anchorage. The company has operated in Washington since 1933 and in Alaska since 1952. With more than 80 years of experience in the region, we deliver innovation, choice, and expertise.