<p>Location: Remote</p><br/><p>Employment Type: Full Time</p><br/><p>Team: Clinical</p><br/><div><span style="font-size: 16px">Hi, we’re Gravie. Our mission is to improve the way people purchase and access healthcare through innovative, consumer-centric health benefit solutions that people can actually use. Our industry-changing products and services are developed and delivered by a diverse group of unique people. We encourage you to be your authentic self - we like you that way.</span></div><div><b style="font-size: 16px">&nbsp;</b></div><div><b style="font-size: 16px">A Little More About the Role:</b></div><div><span style="font-size: 16px">We are seeking an experienced Clinical Operations Manager with deep expertise in Health Plan Operations, cost containment, and clinical strategy. You’ll take what we’re doing - creating a health plan people will love – and play a crucial leadership role in shaping our health plan’s operational and clinical policies, ensuring alignment with industry standards while driving innovative solutions. This role will require a strategic mindset, extensive experience in utilization management, plan language to claims processing, and the ability to influence cross-functional teams to optimize member care and cost efficiencies. You’ll work directly with our Clinical Services, Claims, Stop Loss, Gravie Care, Compliance, external partners including contracted networks, and Reporting teams to create SOPs and help others make equitable decisions.</span></div><div><br></div><div><b style="font-size: 16px">You Will:</b></div><div><span style="font-size: 16px">●&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Serve as a </span><b style="font-size: 16px">strategic clinical leader</b><span style="font-size: 16px"> bridging the clinical team and health plan operations to optimize care delivery and benefit application.</span></div><div><span style="font-size: 16px">●&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Lead the </span><b style="font-size: 16px">design and implementation of clinical protocols, policies, and SOPs</b><span style="font-size: 16px">, ensuring evidence-based practices are embedded into health plan operations.</span></div><div><span style="font-size: 16px">●&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Monitor, evaluate, and coordinate options to facilitate appropriate benefits for members.</span></div><div><span style="font-size: 16px">●&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Evaluate treatment plans, utilization management (UM), and prior authorization (PA) strategies, aligning them with cost containment goals while ensuring optimal member outcomes.</span></div><div><span style="font-size: 16px">●&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Oversee </span><b style="font-size: 16px">policy development and standardization</b><span style="font-size: 16px">, driving consistency across operations.</span></div><div><span style="font-size: 16px">●&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Provide expert guidance on </span><b style="font-size: 16px">Transition of Care, Continuity of Care, Medical Necessity Reviews, Appeals, and Claims Evaluations </b><span style="font-size: 16px">to improve efficiencies.</span></div><div><span style="font-size: 16px">●&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Partner with network UM/CM vendors to enhance accuracy and reduce administrative errors for improved provider and member experiences.</span></div><div><span style="font-size: 16px">●&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Support </span><b style="font-size: 16px">Fraud, Waste, and Abuse detection efforts</b><span style="font-size: 16px">, conducting internal audits and developing policies to mitigate risks.</span></div><div><span style="font-size: 16px">●&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Identify and implement </span><b style="font-size: 16px">cost containment strategies</b><span style="font-size: 16px">, leveraging data analytics to assess trends and recommend improvements.</span></div><div><span style="font-size: 16px">●&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Influence plan language to </span><b style="font-size: 16px">enhance clarity, accessibility, and member satisfaction</b><span style="font-size: 16px">.</span></div><div><span style="font-size: 16px">●&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Synthesize and analyze data in collaboration with </span><b style="font-size: 16px">Clinical Analytics and Reporting teams</b><span style="font-size: 16px">, generating insights to drive continuous improvement initiatives.</span></div><div><span style="font-size: 16px">●&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Act as a trusted </span><b style="font-size: 16px">clinical advisor across the organization</b><span style="font-size: 16px">, supporting executive decision-making with data-driven recommendations.</span></div><div><br></div><div><b style="font-size: 16px">You Bring:</b></div><div><span style="font-size: 16px">●&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Bachelor’s degree in Nursing; Master’s degree in Healthcare Administration, Public Health, or related field preferred.</span></div><div><span style="font-size: 16px">●&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Unrestricted, Active RN or NP license in the state hired.</span></div><div><span style="font-size: 16px">●&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 10+ years of nursing experience, with a significant focus on health plan operations, utilization management, or strategic clinical roles.</span></div><div><span style="font-size: 16px">●&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 3+ years experience in a leadership role, preferably within a health plan, third-party administrator (TPA), or managed care organization.</span></div><div><span style="font-size: 16px">●&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Expertise in medical policy development, UM strategy, and regulatory compliance.</span></div><div><span style="font-size: 16px">●&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Demonstrated experience in cost containment, claims analysis, and fraud prevention methodologies.</span></div><div><span style="font-size: 16px">●&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Exceptional communication, leadership, and cross-functional collaboration skills.</span></div><div><span style="font-size: 16px">●&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Strong analytical mindset with the ability to leverage data for strategic decision-making.</span></div><div><span style="font-size: 16px">●&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Ability to work independently, manage multiple priorities, and drive impactful change.</span></div><div><span style="font-size: 16px">●&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Demonstrated customer service, communication, and organizational skills.</span></div><div><span style="font-size: 16px">●&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Ability to work independently, prioritize effectively, and make sound decisions.</span></div><div><span style="font-size: 16px">&nbsp;</span></div><div><b style="font-size: 16px">Gravie:</b></div><div><span style="font-size: 16px">In order to transform health insurance and build a health plan everyone can love, we need talented people doing amazing work. In exchange, we offer a great overall employee experience with opportunities for career growth, meaningful mission-driven work, and an above average total rewards package.</span></div><div><span style="font-size: 16px">&nbsp;</span></div><div><span style="font-size: 16px">The salary range for this position is $104,332 - $175,554 annually. Numerous factors including, but not limited to, educations, skills, work experience, certifications, etc. will be considered when determining compensation. </span></div><div><span style="font-size: 16px">&nbsp;</span></div><div><span style="font-size: 16px">Our unique benefits program is the gravy, i.e., the special sauce that sets our compensation package apart. In addition to standard health and wellness benefits, Gravie’s package includes alternative medicine coverage, flexible PTO, up to 16 weeks paid parental leave, paid holidays, a 401k program, cell phone reimbursement, transportation perks, education reimbursement, and 1 week of paid paw-ternity leave.</span></div><div><span style="font-size: 16px">&nbsp;</span></div><div><b style="font-size: 16px">A Little More About Us:</b></div><div><span style="font-size: 16px">·&nbsp;&nbsp; &nbsp; We know healthcare. Our company was founded and is still led by industry veterans who have started and grown several market-leading companies in the space.</span></div><div><span style="font-size: 16px">·&nbsp;&nbsp; &nbsp; We have raised money from top tier investors who share the same long-term vision as we do of building an industry defining company that will endure over the long run. We are well capitalized.</span></div><div><span style="font-size: 16px">·&nbsp;&nbsp; &nbsp; Our customers like us. Our revenue churn is in the low single digits, in an industry where greater than 20% churn is common.</span></div><div><span style="font-size: 16px">·&nbsp;&nbsp; &nbsp; Our culture is unique. We tend to be non-hierarchical, merit-driven, opinionated but kind people who thrive working in a high-performance, fast-paced environment. People at Gravie care deeply about making a positive impact in the lives of the people we serve. We may not be the right place for everybody, but if you get energized by doing work every day that focuses on putting consumers at the front of the line, we could be a great place for you. It takes unique people and diverse perspectives to deliver our results. We encourage you to be your authentic self – we like you that way.</span></div>

Location: Remote

  

Employment Type: Full Time

  

Team: Clinical

  

Hi, we’re Gravie. Our mission is to improve the way people purchase and access
healthcare through innovative, consumer-centric health benefit solutions that
people can actually use. Our industry-changing products and services are
developed and delivered by a diverse group of unique people. We encourage you
to be your authentic self - we like you that way.

 ** **

 **A Little More About the Role:**

We are seeking an experienced Clinical Operations Manager with deep expertise
in Health Plan Operations, cost containment, and clinical strategy. You’ll
take what we’re doing - creating a health plan people will love – and play a
crucial leadership role in shaping our health plan’s operational and clinical
policies, ensuring alignment with industry standards while driving innovative
solutions. This role will require a strategic mindset, extensive experience in
utilization management, plan language to claims processing, and the ability to
influence cross-functional teams to optimize member care and cost
efficiencies. You’ll work directly with our Clinical Services, Claims, Stop
Loss, Gravie Care, Compliance, external partners including contracted
networks, and Reporting teams to create SOPs and help others make equitable
decisions.

  

 **You Will:**

●      Serve as a **strategic clinical leader** bridging the clinical team and
health plan operations to optimize care delivery and benefit application.

●      Lead the **design and implementation of clinical protocols, policies,
and SOPs** , ensuring evidence-based practices are embedded into health plan
operations.

●      Monitor, evaluate, and coordinate options to facilitate appropriate
benefits for members.

●      Evaluate treatment plans, utilization management (UM), and prior
authorization (PA) strategies, aligning them with cost containment goals while
ensuring optimal member outcomes.

●      Oversee **policy development and standardization** , driving
consistency across operations.

●      Provide expert guidance on **Transition of Care, Continuity of Care,
Medical Necessity Reviews, Appeals, and Claims Evaluations** to improve
efficiencies.

●      Partner with network UM/CM vendors to enhance accuracy and reduce
administrative errors for improved provider and member experiences.

●      Support **Fraud, Waste, and Abuse detection efforts** , conducting
internal audits and developing policies to mitigate risks.

●      Identify and implement **cost containment strategies** , leveraging
data analytics to assess trends and recommend improvements.

●      Influence plan language to **enhance clarity, accessibility, and member
satisfaction**.

●      Synthesize and analyze data in collaboration with **Clinical Analytics
and Reporting teams** , generating insights to drive continuous improvement
initiatives.

●      Act as a trusted **clinical advisor across the organization** ,
supporting executive decision-making with data-driven recommendations.

  

 **You Bring:**

●      Bachelor’s degree in Nursing; Master’s degree in Healthcare
Administration, Public Health, or related field preferred.

●      Unrestricted, Active RN or NP license in the state hired.

●      10+ years of nursing experience, with a significant focus on health
plan operations, utilization management, or strategic clinical roles.

●      3+ years experience in a leadership role, preferably within a health
plan, third-party administrator (TPA), or managed care organization.

●      Expertise in medical policy development, UM strategy, and regulatory
compliance.

●      Demonstrated experience in cost containment, claims analysis, and fraud
prevention methodologies.

●      Exceptional communication, leadership, and cross-functional
collaboration skills.

●      Strong analytical mindset with the ability to leverage data for
strategic decision-making.

●      Ability to work independently, manage multiple priorities, and drive
impactful change.

●      Demonstrated customer service, communication, and organizational
skills.

●      Ability to work independently, prioritize effectively, and make sound
decisions.



 **Gravie:**

In order to transform health insurance and build a health plan everyone can
love, we need talented people doing amazing work. In exchange, we offer a
great overall employee experience with opportunities for career growth,
meaningful mission-driven work, and an above average total rewards package.



The salary range for this position is $104,332 - $175,554 annually. Numerous
factors including, but not limited to, educations, skills, work experience,
certifications, etc. will be considered when determining compensation.



Our unique benefits program is the gravy, i.e., the special sauce that sets
our compensation package apart. In addition to standard health and wellness
benefits, Gravie’s package includes alternative medicine coverage, flexible
PTO, up to 16 weeks paid parental leave, paid holidays, a 401k program, cell
phone reimbursement, transportation perks, education reimbursement, and 1 week
of paid paw-ternity leave.



 **A Little More About Us:**

·     We know healthcare. Our company was founded and is still led by industry
veterans who have started and grown several market-leading companies in the
space.

·     We have raised money from top tier investors who share the same long-
term vision as we do of building an industry defining company that will endure
over the long run. We are well capitalized.

·     Our customers like us. Our revenue churn is in the low single digits, in
an industry where greater than 20% churn is common.

·     Our culture is unique. We tend to be non-hierarchical, merit-driven,
opinionated but kind people who thrive working in a high-performance, fast-
paced environment. People at Gravie care deeply about making a positive impact
in the lives of the people we serve. We may not be the right place for
everybody, but if you get energized by doing work every day that focuses on
putting consumers at the front of the line, we could be a great place for you.
It takes unique people and diverse perspectives to deliver our results. We
encourage you to be your authentic self – we like you that way.

