Manager, Clinical Escalations
Core
Build and lead a formal clinical escalation program to resolve provider and client complaints, ensuring regulatory compliance and operational integrity.
Role type
Manager, Clinical Operations Program Lead
Builds
A dedicated Escalations Program framework (intake, triage, tracking, reporting) transitioning from Client Success
Domain
US Healthcare / Clinical Operations / Utilization Management
Deliverable
dashboards & analysis
Required skills
Program development, Triage and complaint management, Regulatory compliance (CMS, Medicaid, JCAHO), Data analysis, Process improvement, Cross-functional collaboration, SOP creation, People leadership
Preferred skills
Root cause analysis (RCA), Corrective action planning, Multi-client environment experience, Ticketing/CRM software proficiency
Responsibilities
Design and implement escalation frameworks, Triage and manage client/provider complaints, Monitor open escalations and hold teams accountable, Enforce mandatory response times, Handle executive-level escalations, Report on trends and performance metrics, Lead and develop an Escalations Analyst, Collaborate cross-functionally to address systemic issues
Seniority
Manager, hands-on IC with team leadership