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Full Time Clinical Nurse Specialist Job MI

Full Time
Great Location, MI
alarm 2 months ago
Posted by MPRO
Employer MPRO

Job Description


The Program Manager works closely with the Director of Medical Review Services and is responsible for overseeing the day-to-day operations of medical review programs and contracts, including ensuring the quality and timeliness of all deliverables. They work with the director to determine tactics for increasing review service business lines, along with actively responding to new opportunities. The Program Manager provides guidance to direct reports and works to identify efficiencies. 


  • Manage daily operations of assigned project/contract area, including working with the director to establish and monitor budgets.
  • Mentor, guide and provide day-to-day supervision of direct reports.
  • Provide oversight of direct reports and assist with identification of strategies to ensure assigned roles and responsibilities, as described in the corresponding job description, are met.   
  • Comprehend and monitor all contract aspects related to assigned task(s), including deliverable schedule and metrics, keeping the director informed of potential risks.
  • Ensure all contract activities are delivered in accordance with quality, performance, timeliness, and financial metrics working with team members to mitigate barriers.
  • Complete tasks as designated by the director.
  • Delegate activities according to job and skill levels.
  • Actively partake in identifying and securing new business opportunities. 
  • Coach, facilitate and implement methods aimed at creating a high-functioning integrative team.
  • Apply quality principles knowledge, acquired clinical/technical expertise and medical review experience to employ strategies to support attainment of contract goals.
  • Initiate development of job aids and standard operating procedures.
  • Proactively identify challenges and deploy mitigation strategies.
  • Model accountability for self-learning activities as well as the sharing and transfer of knowledge.
  • Attend and/or presents at local, state or national conferences/meetings, as appropriate.
  • Develop external relationships and maintain customer satisfaction.
  • Adhere to all relevant compliance regulations (HIPAA, FISMA, URAC, CMS).


  • Bachelor’s degree in nursing. Master’s degree preferred
  • Active nursing licensure in any state
  • Minimum of 3 years of clinical or related healthcare experience required
  • Minimum 1-year management experience required
  • Extensive medical review experience required, Workers Compensation, Utilization Management, Claims Review, External and Quality Review experience preferred
  • Minimum of 2 years of quality improvement experience required
  • Ability to read and interpret federal/state contracts and regulations
  • Excellent written and verbal communication skills required
  • Exceptional organizational, project management and customer service skills required
  • Experience with written and electronic documentation review
  • Ability to multi-task working on more than one contract/project simultaneously
  • Excellent customer service skills required
  • Proficient in Milliman and/or InterQual systems
  • Ability to travel, both in and out of state
  • Ability and willingness to work off hours, weekends and holidays as needed to ensure deadlines and deliverables are met