Healthcare Management Administrators

Manager, Clinical Cost Containment

Healthcare Management Administrators

full-time

Posted on:

Location Type: Remote

Location: Washington • United States

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Salary

💰 $110,000 - $140,000 per year

About the role

  • The Clinical Cost Containment Manager is responsible for the operational development and execution of value programs within Care Management.
  • This program is designed to promote health and financial savings for members and clients with a focus on preventing inappropriate or incorrect claim payments prior to adjudication.
  • This dynamic role understands performance trends, monitors for variances and can present findings to other leaders and partners.
  • The leader oversees prepayment clinical review, medical necessity validation, and coding accuracy initiatives to ensure claims are compliant with benefit plans, coding and clinical guidelines, and regulatory requirements while supporting cost containment for self-funded employer clients.
  • You will develop deep subject-matter-expertise and understanding of our customers and our TPA market so you can be a trend-setter, continuously improving processes and effective delivery to maximize the value of HMA’s cost containment services.
  • You will lead a diverse team of coders and nurses to achieve the program objectives.
  • This leader partners closely with Utilization Management, Analytics, Finance, Compliance and Client Success while growing capabilities for promoting value at HMA.

Requirements

  • Bachelor's degree or equivalent required in related field
  • 3-5+ years of experience in leadership within the healthcare, insurance, revenue cycle, payment integrity, or cost-containment industries
  • Strong understanding of healthcare claims coding (CPT, HCPCS, ICD‑10) and its impact on reimbursement and claims adjudication.
  • Excellent technical and organizational skills with a successful track record of accountability for end-to-end delivery of operational initiatives
  • Strong data analysis skills, with the ability to make data-driven business recommendations quickly
  • Demonstrated experience building program growth strategies with medium to long term program roadmaps
  • Communicate well and influence direct reports, colleagues and executives
  • Expert problem solving and organizational abilities
  • Experience collaborating and communicating with different stakeholders
  • Ability to lead, develop, motivate, and hold others accountable
  • Highly developed relationship-building skills
  • Experience with MS Office Suite including advanced PowerPoint skills
Benefits
  • Seventeen (IC) days paid time off (individual contributors)
  • Eleven paid holidays
  • Two paid personal and one paid volunteer day
  • Company-subsidized medical, dental, vision, and prescription insurance
  • Company-paid disability, life, and AD&D insurances
  • Voluntary insurances
  • HSA and FSA pre-tax programs
  • 401(k)-retirement plan with company match
  • Annual $500 wellness incentive and a $600 wellness reimbursement
  • Remote work and continuing education reimbursements
  • Discount program
  • Parental leave
  • Up to $1,000 annual charitable giving match
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
healthcare claims codingCPTHCPCSICD-10data analysisoperational initiativesprogram growth strategiescost containmentpayment integrityrevenue cycle
Soft Skills
leadershipcommunicationinfluenceproblem solvingorganizational abilitiesrelationship-buildingcollaborationmotivationaccountabilitydata-driven decision making