Clinical Operations Manager

This is a fully remote position, open to applicants in New Jersey.

📋 Description

• Supervise departmental operations to guarantee effective and compliant service delivery in accordance with regulatory requirements, company policies, and HIPAA standards.

• Manage daily workflows and modify operations to meet quality, productivity, and service objectives.

• Control operating expenses and resources to support both departmental and organizational goals.

• Provide support, training, tools, and resources to staff.

• Review and analyze quality assurance and performance metrics, implementing strategies for improvement.

• Act as the clinical subject matter expert for the department on treatment trends, industry best practices, and regulatory requirements.

• Maintain familiarity with New Jersey AICRA and Michigan PIP regulations, ensuring operational processes are aligned accordingly.

• Collaborate with physician panel members and consulting clinical resources on quality initiatives, clinical consistency, and program development.

• Monitor clinical and treatment trends, recommending process improvements and operational enhancements.

• Oversee and assist with provider appeals and complex clinical issues.

• Organize and take part in staff meetings, fostering communication across various lines of business.

• Address customer service needs and resolve complicated customer service situations.

• Communicate client-specific requirements, operational changes, and special instructions to staff.

• Ensure that activities and operations adhere to relevant local, state, and federal laws and regulations.

• Perform additional duties as assigned.

⛳️ Requirements

• Bachelor's degree in nursing, business management, healthcare administration, or a related field is preferred.

• A minimum of six years of relevant clinical experience, including at least three years in a leadership or management role; or an equivalent combination of education and experience.

• Experience in PIP, No-Fault, Workers' Compensation, or the managed care industry.

• Previous leadership or management experience is required.

• Experience in utilization review, clinical operations, and insurance-related healthcare services is preferred.

• An active, unencumbered Registered Nursing license is required.

• Strong understanding of medical terminology, anatomy and physiology, medications, laboratory values, and evidence-based treatment practices.

• General knowledge of automobile claims regulations related to No-Fault (PIP) programs and utilization review practices.

• Familiarity with nationally recognized treatment guidelines and evidence-based clinical review resources.

• Working knowledge of medical records, health information principles, and medical-legal documentation.

• Exceptional analytical, critical thinking, clinical judgment, decision-making, problem-solving, and communication skills.

• Proficient in Microsoft Word, Outlook, Excel, Internet applications, and other business-related software.

• Ability to operate standard office equipment.

• Capability to collaborate with physicians, healthcare providers, clients, and internal stakeholders.

• Ability to work independently, prioritize tasks, and manage multiple competing priorities.

• Ability to maintain confidentiality and manage sensitive information appropriately.

• Ability to perform effectively under pressure, meet deadlines, and adapt to changing priorities while managing unexpected situations.

• Ability to adhere to company policies and procedures.

🏝️ Benefits

• Medical, vision, and dental benefits.

• Paid time off.

• 401k.

• Fully remote work.