Manager, Clinical Services Business Insights

Manager, Clinical Services Business Insights

Provides oversight of strategy, auditing, training, analytics, and reporting for the Clinical Services business unit. Responsible for daily oversight of monitoring programs, managing department projects and internal and external reporting of Clinical Services programs. Ensures Clinical Service programs and processes align with applicable regulatory standards including Centers for Medicare and Medicaid (CMS), Dual Eligible Special Needs Plans (DSNP) Model of Care (MOC), Health Care Authority (HCA), and National Commission for Quality Assurance (NCQA).

Qualifications :

Education & Prior Related Experience :

A bachelor's degree in a relevant field such as Public Health, Health Informatics, Business Administration, or a related discipline; a relevant master's degree, such as MPH, MHA, MBA, or MS in Analytics is highly preferred. Have five (5)+ years of progressive experience in project management, program management, or healthcare analytics with at least three (3) years in a leadership or supervisory role, required. Have a minimum of three (3) years of working experience at a Managed Care Organization (MCO), required. Have experience managing large scale projects with both clinical and non-clinical stakeholders, required. Have experience as a strategic partner to clinical leadership, translating business needs into technical requirements and ensuring outputs are aligned with operational priorities. Professional certifications demonstrating expertise in project management, analytics, or process improvement preferred.

Essential functions and Roles and Responsibilities :

Manages staff, including coaching direct reports for optimal performance. Responsible for divisional auditing and reporting to ensure compliance with department productivity metrics and regulatory requirements. Provides operational oversight and supervision of staff performing internal & external Auditing Process Oversight for Clinical Services. Collaborate closely with clinical leaders to identify opportunities for intervention, monitor program performance, and evaluate program effectiveness and impact. Lead cross-functional analytics and reporting projects from initiation through execution, ensuring alignment with clinical operations goals across care management.