Clinical Operations Manager

Clinical Operations Manager

The Clinical Operations Manager will manage the activities of a team of clinical case managers supporting STD, FMLA and LTD. Also, the Clinical Operations manager will provide oversight and asst in training of all clinical protocols and best practices used by our absence management clinical staff, including Registered Nurses, and Vocational Rehabilitation Counselors. The Clinical Operations Manager will serve as a Senior Clinical reviewer for highly complex, high-profile escalated claims.

You will

• Manage a team of clinical case managers (CCM’s)
• Lead, motivate, and develop assigned clinical case manager staff
• Assess and monitor clinical case manager’s workload capacity and efficiency
• Assess and measure staff performance and set appropriate goals
• Perform mid-year and annual performance evaluations, communicating expectations, goals, deadlines and team results
• Monitor and control personnel issues of clinical claim managers and work directly with Human Resources as needed
• Coordinate with other clinical operations managers to provider clinical case management support across Alight’s book of business.
• Conduct clinical audits and provide feedback and mentoring, coordinate with clinical leaders on corrective actions as applicable
• Support operations claims teams by monitoring and resolving escalated customer complaints related to clinical issues
• Participate in the reinforcement of return-to-work best practice protocols and workflows
• Occasionally assist with overflow of clinical reviews upon request of manager
• Perform side by side listening/shadowing and coaching with team members to assist in further development of clinical staff.
• Collaborate with senior clinical reviewer for highly complex high profile disability claims and/or escalated claims.
• Conduct regular clinical round tables to determine level of functional impairment based on knowledge of medical signs and symptoms and the employer’s essential job functions and reinforce methodology of reviewing claims based on best practice case review per Medical disability guidelines review protocol.

You have

• RN license
• 1-3 years minimum of clinical experience
• Minimum of 5 years of experience in disability management and/or managed care
• 2+ years of supervisory experience
• Unrestricted state clinical licensure
• Superior clinal case manager skills and eagerness to function in a leadership role
• Strong teaching or mentorship skills
• Advanced problem-solving and analytical skills
• Excellent communication (written/verbal) and relationship building skills
• Superior ability to work in a team setting
• Ability to communicate complex information in a mentoring/training situation
• Strong organization skills, time management and follow-through are essential
• Strong presentation skills

We offer you a competitive total rewards package, continuing education & training, and tremendous potential with a growing worldwide organization.

DISCLAIMER:

Nothing in this job description restricts management's right to assign or reassign duties and responsibilities of this job to other entities; including but not limited to subsidiaries, partners, or purchasers of Alight business units.

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Experience Level

Mid Level