Clinical Operations Manager

🔥 6 minutes ago

🏖️ New Jersey – Remote

🏖️ New Jersey – Remote

💵 $100k - $120k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🏥 Clinical Operations

👻 Ghost score 0%

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ExamWorks

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 2008

🏥 Healthcare

💼 Consulting

⚖️ Legal

Healthcare • Consulting • Legal

ExamWorks is a leading provider of independent medical examinations and peer reviews, specializing in services such as bill reviews, Medicare compliance, and document management. With a robust portfolio that includes agile development and enterprise platform solutions, ExamWorks ensures efficient workflow enhancements and compliance auditing across healthcare sectors. The company supports a network of physicians and offers customized services for the management of medical records and claims, prioritizing reliability for clients in various communities.

📋 Description

• Oversee departmental operations to ensure effective, compliant service delivery under regulatory requirements, company policies, and HIPAA standards • Manage daily workflows and adjust operations to achieve quality, productivity, and service goals • Control operating expenses and resources to support departmental and organizational objectives • Provide staff support, training, tools, and resources • Review and analyze quality assurance and performance data and implement improvement strategies • Serve as the department's clinical subject matter expert on treatment trends, industry best practices, and regulatory requirements • Maintain knowledge of New Jersey AICRA and Michigan PIP regulations and align operational processes accordingly • Collaborate with physician panel members and consulting clinical resources on quality initiatives, clinical consistency, and program development • Monitor clinical and treatment trends and recommend process improvements and operational enhancements • Oversee and assist with provider appeals and escalated clinical issues • Organize and participate in staff meetings and promote communication across lines of business • Respond to customer service needs and resolve complex customer service situations • Communicate client-specific requirements, operational changes, and special instructions to staff • Ensure activities and operations comply with applicable local, state, and federal laws and regulations • Perform other duties as assigned

🎯 Requirements

• Bachelor's degree in nursing, business management, healthcare administration, or related field preferred • Minimum of six years related clinical experience, including at least three years of leadership or management experience; or equivalent combination of education and experience • Experience in PIP, No-Fault, Workers' Compensation, or managed care industry • Prior leadership or management experience • Experience in utilization review, clinical operations, and insurance-related healthcare services preferred • Active unencumbered Registered Nursing license required • Strong knowledge 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 • Working knowledge of nationally recognized treatment guidelines and evidence-based clinical review resources • Working knowledge of medical records, health information principles, and medical-legal documentation • Strong analytical, critical thinking, clinical judgment, decision-making, problem-solving, and communication skills • Proficiency in Microsoft Word, Outlook, Excel, Internet applications, and other business-related software • Ability to operate standard office equipment • Ability to collaborate with physicians, healthcare providers, clients, and internal stakeholders • Ability to work independently, prioritize responsibilities, and manage multiple competing priorities • Ability to maintain confidentiality and handle sensitive information appropriately • Ability to work effectively under pressure, meet deadlines, adapt to changing priorities, and manage unexpected situations • Ability to follow company policies and procedures

🏖️ Benefits

• Medical, vision, and dental benefits • Paid time off • 401k • Fully remote work