Program Manager – Clinical Operations

About This Opportunity

Our talent team is representing a confidential healthcare services organization in their search for a Program Manager - Clinical Operations. This remote position offers the opportunity to lead strategic clinical programs that directly impact member outcomes and healthcare delivery efficiency across the United States.

As the Program Manager, you'll partner with clinical leaders, care managers, analytics teams, and client stakeholders to drive operational excellence in care management, utilization management, and population health initiatives. This role sits at the intersection of healthcare strategy and execution, making it ideal for experienced professionals who thrive on improving both clinical outcomes and operational performance.

Responsibilities

• Lead end-to-end management of clinical operations programs including planning, implementation, monitoring, and optimization across care management and utilization management workstreams
• Establish program governance, project plans, milestones, and performance metrics while ensuring timely delivery of strategic initiatives
• Drive initiatives focused on reducing avoidable admissions, readmissions, emergency department utilization, and total cost of care
• Support value-based care initiatives through performance monitoring and outcome improvement strategies utilizing healthcare analytics
• Serve as primary point of contact for internal and external stakeholders, facilitating collaboration across clinical, operational, technology, quality, and analytics teams
• Present program performance, operational updates, risks, and recommendations to leadership and clients
• Ensure adherence to NCQA, CMS, HIPAA, URAC, and client-specific requirements while supporting audit readiness
• Develop and monitor KPIs, operational dashboards, and program scorecards to identify optimization opportunities
• Identify program risks, operational challenges, and process gaps while developing mitigation strategies
• Support implementation and enhancement of clinical programs targeting high-risk and complex populations

What We're Looking For

Required Qualifications:

• Bachelor's degree in Healthcare Administration, Nursing, Public Health, Life Sciences, Business Administration, or related field
• 7+ years of experience in healthcare operations, care management, utilization management, population health, or clinical program management
• 3+ years of experience leading cross-functional programs or large-scale operational initiatives
• Strong understanding of healthcare payer and provider operations
• Experience working with clinical and operational performance metrics

Preferred Qualifications:

• Master's degree (MBA, MHA, MPH, MSN, or equivalent)
• PMP, Lean Six Sigma, or Healthcare Quality certifications
• Experience with Value-Based Care, Risk Adjustment, Population Health Management, HEDIS, STAR Ratings, or Care Management programs
• Familiarity with EMR/EHR systems, care management platforms, and healthcare analytics tools

Core Competencies:

• Program and portfolio management in healthcare settings
• Clinical operations leadership and process improvement
• Population health management and utilization management expertise
• Healthcare analytics, reporting, and data-driven decision making
• Regulatory compliance knowledge (NCQA, CMS, HIPAA, URAC)
• Stakeholder and client management skills
• Strategic thinking and change management capabilities

How We Work With You

When you apply through Get A Job.ai, our recruiting team will review your qualifications and schedule an initial screening call with candidates who match the role requirements. We'll discuss your experience with clinical operations, program management, and healthcare initiatives in detail.

After our screening, we'll submit qualified candidates directly to our client for consideration. Throughout the interview process, we'll provide guidance and support. Please do not contact the client directly—all communication should flow through our recruitment team to ensure a smooth and professional process.

Pay

Compensation details will be discussed during the screening process based on experience and qualifications.

Location: Remote, United States

Employment Type: Full-time

Get A Job.ai is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all candidates and employees.