Clinical Operations Manager

CareOregon; Nevada (IA); Remote; USD 135,000 - 166,000; Full time

Job summary

A leading healthcare organization is seeking a Clinical Operations Manager to oversee multiple clinical teams and ensure effective healthcare delivery. This fully remote position requires strong leadership skills, a current RN license, and significant nursing experience. The role involves collaboration across departments to enhance operational efficiency and patient care.

Qualifications

• Current unrestricted RN license for Oregon.
• At least 5 years' nursing experience, including 2 years in utilization or case management.

Responsibilities

• Oversee operational and clinical functions of multiple teams.
• Develop and implement standards and procedures.
• Manage team and set aligned goals.

Skills

Time management

Communication

Problem-solving

Interpersonal skills

Collaboration

Negotiation

Staff management

Technical proficiency

Education

Bachelor’s or Master’s degree in Nursing or health-related field

Job description

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Candidates hired for remote positions must reside in Oregon, Washington, Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin.

Job Title

Clinical Operations Manager

Department

Clinical Operations

Exemption Status

Exempt

Requisition #

24994

Direct Reports

Team Supervisors and Support Staff

Manager Title

Director, Clinical Operations

Pay & Benefits

Estimated hiring range $135,420 - $165,520 /year, 5% bonus target, full benefits. More info

Posting Notes

This is a fully remote position, but you must reside in one of the listed 9 states. The schedule is Monday – Friday, with potential to move to a 4/10 schedule in the future.

Job Summary

This position manages multiple clinical and non-clinical teams, overseeing areas like prior authorizations, referrals, concurrent review, and DME. Responsibilities include developing and implementing standards and procedures, monitoring impact, and ensuring effectiveness. The role involves collaboration across the organization to support goals.

Essential Responsibilities

Operational Management

1. Oversee operational and clinical functions of multiple teams.
2. Collaborate with department leaders to monitor program standards, impact, and effectiveness.
3. Lead teams in achieving goals.
4. Develop utilization programs ensuring resource use meets medical and cost criteria.
5. Ensure policies meet CareOregon/DMAP and CMS requirements.
6. Maintain compliance with regulatory bodies.
7. Coordinate work across functional areas and communicate with partners.
8. Serve as a technical resource for supervisors.
9. Coordinate with other departments and serve as liaison.
10. Stay current on standards for health plan operations.
11. Analyze data for improvement opportunities.
12. Communicate with providers and partners for workflow improvements.
13. Monitor utilization outliers and coordinate with Finance and reinsurers.
14. Collaborate with IS on system performance and reporting.

Program Development, Improvement, and Evaluation

1. Develop and follow program guidelines.
2. Identify and implement improvements.
3. Monitor and improve program metrics.
4. Foster a professional and team-oriented environment.

Employee Supervision

1. Manage team and set aligned goals.
2. Identify staffing needs, recruit, and hire with an equity lens.
3. Plan, organize, and monitor work.
4. Develop and communicate goals and expectations.
5. Train, motivate, and support staff development.
6. Integrate equity principles into leadership and operations.
7. Ensure policy adherence.
8. Evaluate performance and provide feedback.
9. Collaborate with HR for supervisory tasks.

Organizational Responsibilities

1. Align work with organizational mission, vision, and values.
2. Support equity, diversity, and inclusion initiatives.
3. Work toward annual business and strategic goals.
4. Follow policies and compliance requirements.
5. Perform additional duties as needed.

Minimum Requirements

• Current unrestricted RN license for Oregon.
• At least 5 years' nursing experience, including 2 years in utilization or case management.

Preferred Qualifications

• 2+ years supervisory experience or 1+ years with CareOregon’s Aspiring Leaders Program.
• Bachelor’s or Master’s degree in Nursing or health-related field.
• Experience with process improvement, project management, and health plans, especially Oregon-specific programs.
• Certifications like NCQA Accreditation, CPUM, CPHM, CCM, or CMCN.

Knowledge, Skills, and Abilities

Knowledge

• Managed care principles, health plan regulations, utilization management, care coordination, and disease management.

Skills & Abilities

• Time management, communication, problem-solving, interpersonal skills.
• Collaboration, stress management, negotiation, staff management, and technical proficiency.
• Ability to develop procedures, manage multiple projects, and work in diverse teams.

Working Conditions

• Indoor/Office environment, remote work from home.
• May include occasional travel.
• Physical and ergonomic hazards possible.

CareOregon encourages candidates of color and veterans to apply and is committed to diversity and inclusion. Equal opportunity employer. No visa sponsorship available.