Clinical Program Manager

WHO WE ARE

NeueHealth is a value-driven healthcare company grounded in the belief that all health consumers are entitled to high-quality, coordinated care. By uniquely aligning the interests of health consumers, providers, and payors, we help to make healthcare accessible and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid.

NeueHealth delivers clinical care to health consumers through our owned clinics – Centrum Health and Premier Medical – as well as unique partnerships with affiliated providers across the country. We also enable providers to succeed in performance-based arrangements through a suite of technology and services scaled centrally and deployed locally. Through our value-driven, consumer-centric approach, we are committed to transforming healthcare and creating a better care experience for all. 

JOB SUMMARY

The Clinical Program Manager of Specialty Solutions will develop and manage clinical pathways for various health conditions. Responsibilities include applying deep knowledge of clinical information and regulatory requirements to develop clinical pathways that will provide decision support for our employed and affiliated providers. This position will also provide leadership and manage cross-functional work teams and provide core clinical subject matter expertise for Specialty Solutions’ overall strategies.

DUTIES & RESPONSIBILITIES

• Lead the development, validation, and periodic review of evidence-based clinical guidelines used within the decision support tool. Review guideline outputs and alerts for clinical accuracy and relevance.
• Partner with value-based care medical director and NeueHealth CMO to develop clinical guideline pathways.
• Develop and maintain any company policies related to the clinical decision support tool.
• Stay up to date on evolving clinical research, practice guidelines, and regulatory changes to inform timely updates to the clinical decision support content.
• Support clinical governance processes. Maintain comprehensive documentation for all clinical guidelines, including rationale, version history, evidence sources, and review schedules.
• Utilize clinical data and system usage metrics to inform updates and refinements.
• Ensure clinical guidelines align with internal policies, applicable regulatory Federal and State requirements, and accreditation standards.
• Support tool utilization through cross-functional communication with other departments.
• Identify opportunities for quality and process improvements necessary to facilitate best use of the decision support tool.
• Contribute to training materials, user guides, and clinical documentation. As needed, provide education for staff.
• Other duties and responsibilities as assigned.

EDUCATION AND PROFESSIONAL EXPERIENCE

• Bachelor’s or associate degree in nursing and / or Doctor of Medicine degree required.
• Minimum three (3) years of clinical experience required. Experience within clinical program management, clinical guideline development, clinical compliance, Utilization Management / Case Management, and / or clinical research preferred.
• Working knowledge and understanding of clinical guidelines required.
• Previous experience managing cross-functional teams on large scale projects required.
• Prior experience with a highly regulated environment including Federal, State and national accreditation standards preferred.

PROFESSIONAL COMPETENCIES

• Experience with problem management, change control and how to influence change without direct control within a decentralized business unit culture.
• Experience managing cross-functional teams with high visibility across products/business capabilities with experience identifying and managing dependencies within and across teams preferred.
• Excellent writing skills, particularly in determination notification writing.
• Ability to develop strong cross-functional and collaborative relationships with internal and external partners, including the ability to work with a wide variety of people and personalities.
• Must be self-motivated, able to take initiative, and ability to thrive and drive results in a collaborative environment.
• Must possess strong organizational and prioritization skills and competence and capacity to handle multiple initiatives while managing conflicting priorities.
• Experience in using the Microsoft Office Suite including Excel and Word as well as demonstrated ability to learn/adapt to other computer-based systems and tools.