Manager, Clinical Operations - BDU

Who We Are At Lucet, we’re transforming whole-person care. We deliver integrated behavioral and physical health solutions that connect individuals to the right care at the right time—improving outcomes and overall well-being. Serving over 15 million lives across the U.S. and Puerto Rico, our model combines clinical expertise, compassionate care, and innovative technology to support healthier, more fulfilling lives. As part of the Lucet team, employees join a mission-driven organization committed to making a lasting impact. Whether through behavioral health navigation, in-home medical care, or 24/7 crisis support, our work is rooted in empathy, collaboration, and a shared passion for helping people thrive. Why Join our Team At Lucet, we’re committed to creating a workplace where top talent thrives both personally and professionally. We offer a dynamic, mission-driven environment where your work has real impact, your unique background and experience are valued, and no two days are alike. If you’re passionate about meaningful work and delivering impactful results, we encourage you to apply! We support our team with a competitive compensation and benefits package, including: Annual compensation between $85,000 - $90,000, PLUS an annual performance-based, discretionary incentive. Compensation is dependent on non-discriminatory factors including but not limited to an applicant's skills, education/degrees, certifications, prior experience, market data, and other relevant factors. Comprehensive health benefit options: Medical, dental, and vision coverage 401(k) with competitive employer match Company-paid life and disability insurance Paid parental leave and wellbeing incentives Generous paid time off, including volunteer time Flexible spending accounts for healthcare and dependent care Professional development opportunities and tuition reimbursement Remote work flexibility (role-dependent) Opportunity for meaningful growth, both personally and professionally, where your unique background and experience is welcomed and valued. At Lucet, your work will directly support our mission to improve behavioral, physical, and social health—one member at a time. What You Will Do - Essential Functions Strategic Leadership & Operational Excellence Lead Benefit Determination Unit operations, ensuring timely, accurate, and compliant utilization management activities while achieving organizational objectives. Oversee performance, resource utilization, complex case escalations, and operational initiatives to drive efficiency and service excellence. Quality, Compliance & Performance Management Ensure compliance with regulatory, accreditation, contractual, and organizational requirements through oversight of utilization management processes and quality activities. Monitor performance metrics, audits, and operational reviews, implementing improvements and corrective actions to enhance quality, efficiency, and outcomes. Team Leadership, Collaboration & Partnership Lead, coach, and develop a high-performing team while fostering accountability, collaboration, and continuous improvement. Partner with appeals teams, health plans, providers, clients, and internal stakeholders to support coordinated care, effective benefit determinations, and client satisfaction. Who You Are Required Qualifications Current, active, and unrestricted license issued by a state or territory of the United States to practice independently with a legal scope of practice that permits independent assessments; Clinical Social Worker, Marriage and Family Therapist, Professional Counselor, Clinical Psychologist or Registered Nurse in the state in which the business operation is located and/or other states as required by law, regulation or contract. Bachelor's degree in Nursing, Social Work, Counseling, Psychology, or a related healthcare field 5+ years of clinical experience in utilization management, care management, behavioral health, healthcare operations, or a related clinical setting. 3+ years of experience in a formal clinical supervisory position or demonstrated leadership capacity. Strong knowledge of utilization management principles, medical necessity criteria, benefit determination processes, appeals, and clinical review functions. Working knowledge of state and federal regulatory requirements, accreditation standards (e.g., NCQA, URAC), and health plan contractual obligations. Experience analyzing performance metrics, managing operational workflows, and leading quality improvement initiatives. Excellent communication, stakeholder management, problem-solving, and decision-making skills. Proficiency with clinical documentation systems, care management platforms, and Microsoft Office applications. Obtain certification in Case Management (CCM) within 3 years of directly supervising the case management process (applicable when overseeing care management teams). Ability to travel 10% of the time. Ability to pass a background check upon hire and throughout employment which includes: County and Federal Criminal Records Search - felonies and misdemeanors ; InstaCriminal Multi-State Alias Search - National Sex Offender Registry, Multi-State Criminal Database, SSN validation and trace, and Most Wanted Lists (OFAC); Excluded Parties List System (EPLS)/SAM search - individuals/entities debarred, suspended, or otherwise excluded from receiving federal contracts, subcontracts, or federal assistance; Education Verification; Employment Verification; FACIS Level I - Sanctions or exclusions for federal and state healthcare programs; 10-panel drug screening; and E-Verify: Lucet does not use E-Verify to pre-screen applicants and complies with federal regulations prohibiting discrimination based on national origin or citizenship status. Living our Values: Serving everyone with compassion and leading with empathy. Stepping up and creating value by taking charge and acting when there is an opportunity. Adapting in a changing world by recognizing our responsibility to be agile and respond quickly. Nurturing growth and belonging by respecting and celebrating everyone for who they are. Competencies: Professional demeanor and ability to work collaboratively with multiple levels of professionals and staff Strong attention to detail Demonstrates consistency in professional demeanor in response to all situations regardless of the nature or circumstances of the situation Ability to manage multiple tasks in a fast-paced, changing environment Ability to assume a lead role in ensuring that all objectives are met Working Conditions: Work is performed from home with company-provided equipment. Sitting for long periods of time is expected and use of fingers and hands for typing is necessary. A quiet workspace with minimal background noise for calls. High-speed internet service (cable or fiber optic) with minimum download Speed of 20 Mbps, Upload Speed of 5 Mbps, and Maximum Latency of 100 milliseconds (must be installed before starting). We encourage applicants from a variety of backgrounds and experiences to apply, especially those who can demonstrate how their unique qualifications and skills align with the requirements of this role and support our mission to improve whole-person health. This position will accept and review new applications and resumes no less than 5 business days after the original posting date and may remain open an extended period of time with no set end date based on the level of interest.