Clinical Operations Manager

CareOregon; Washington (District of Columbia); Remote; USD 135,000 - 166,000; Full time

Job summary

A leading healthcare organization is seeking a Clinical Operations Manager to oversee multiple clinical and non-clinical teams. This fully remote role involves managing operational functions, ensuring compliance with regulatory requirements, and fostering a culture of equity and inclusion. Candidates must have a valid RN license and significant nursing experience.

Qualifications

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

Responsibilities

• Oversee operational and clinical functions of multiple teams.
• Manage team, set goals, recruit, and hire with an emphasis on equity and inclusion.
• Develop and monitor program guidelines and performance metrics.

Skills

Leadership

Communication

Problem-Solving

Organizational Skills

Education

Bachelor’s or Master’s degree in Nursing or related health 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. Details here

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 for a 4/10 schedule in the future.

Job Summary

This role manages multiple clinical and non-clinical teams, overseeing areas like prior authorizations, referrals, concurrent review, and DME. Responsibilities include developing program standards, monitoring impact, ensuring effectiveness, and collaborating across departments to meet organizational goals.

Essential Responsibilities

Operational Management

• Oversee operational and clinical functions of multiple teams.
• Collaborate with department leaders on program standards and impact evaluation.
• Lead team goal-setting and achievement.
• Develop utilization programs ensuring resource use aligns with medical and cost criteria.
• Ensure policies meet CareOregon, DMAP, CMS, and other regulatory requirements.
• Coordinate work across functional areas and communicate with internal and external stakeholders.
• Serve as a technical and operational resource to supervisors.
• Maintain current knowledge of health plan operation standards.
• Analyze data for improvement opportunities and communicate with providers and finance teams.
• Collaborate on system performance and reporting improvements.

Program Development, Improvement, and Evaluation

• Develop and monitor program guidelines and performance metrics.
• Identify and implement process improvements.
• Create a professional, team-oriented environment.

Employee Supervision

• Manage team, set goals, recruit, and hire with an emphasis on equity and inclusion.
• Organize, train, motivate, and evaluate staff performance.
• Incorporate organizational equity tools into leadership practices.
• Ensure policy adherence and support employee development.

Organizational Responsibilities

• Align work with organizational mission, vision, and values.
• Promote a culture of equity, diversity, and inclusion.
• Support strategic goals and comply with policies and regulations.

Minimum Requirements

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

Preferred Qualifications

• Supervisory experience or completion of CareOregon’s Aspiring Leaders Program.
• Bachelor’s or Master’s degree in Nursing or related health field.
• Experience in process improvement, project management, and Medicaid/Medicare regulations.
• Certifications like NCQA Accreditation, CPUM, CPHM, CCM, etc.

Knowledge, Skills, and Abilities

• Deep understanding of managed care, health plan regulations, and utilization management.
• Strong organizational, communication, problem-solving, and leadership skills.
• Ability to work under pressure, collaborate effectively, and manage multiple projects.
• Proficiency with basic health plan computer systems and training staff in new processes.
• Effective team leadership and cultural competency.

Working Conditions

• Indoor/Office environment, work from home.
• May involve travel using personal vehicle or transit.
• Physical and ergonomic hazards possible.

CareOregon encourages candidates of color and veterans to apply. We are committed to diversity and inclusion.