Clinical Operations Manager (33121)

ExamWorks, Inc.; Mount Laurel Township (NJ); Remote; USD 95,000 - 145,000; Full time

Benefits offered by this job

Medical benefits

Vision and dental

Paid time off

401(k)

Job summary

ExamWorks is seeking a Clinical Operations Manager to lead a remote team and oversee PIP, No-Fault, WC, and managed care programs. You will shape clinical programs, develop guidelines, mentor staff, and drive quality improvements across regulatory and client requirements.

The role emphasizes collaboration with physicians and operations leaders to optimize workflows, ensure HIPAA compliance, and scale processes for growth while maintaining the highest standards of care.

Qualifications

• 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.
• Experience in utilization review, clinical operations, and insurance-related healthcare services preferred.
• Knowledge of the insurance industry and no-fault (PIP), workers' compensation, liability, and disability claims environments preferred.

Responsibilities

• Oversee departmental operations to ensure services are delivered effectively and in compliance with all regulatory requirements, company policies, and HIPAA standards.
• Ensure daily workflow is managed efficiently and adjust as necessary to achieve quality, productivity, and service goals.
• Maintain control of operating expenses and resources to support departmental and organizational objectives.
• Create and provide support, training, tools, and resources to assist staff in achieving departmental excellence and maintaining company standards.
• Review and analyze quality assurance and performance data and implement improvement strategies to enhance quality, consistency, and productivity.
• Serve as the department's clinical subject matter expert regarding treatment trends, industry best practices, and regulatory requirements.

Skills

Leadership experience

Utilization review

Quality improvement

Regulatory compliance

Cross-functional collaboration

Education

Bachelor's degree in nursing, business management, healthcare administration, or related field

Tools

Microsoft Word

Outlook

Excel

Internet applications

Job description

Are you a clinical leader with experience in PIP, Workers' Compensation, utilization review, or managed care who enjoys improving processes, mentoring teams, and driving quality outcomes?

ExamWorks is seeking a Clinical Operations Manager to play a key role in shaping and enhancing our clinical programs while leading a high-performing remote team.

In this 100% fully remote position, you'll provide clinical leadership across utilization management and No-Fault (PIP) programs, helping ensure services are delivered efficiently, compliantly, and with the highest level of quality. You'll partner with operational leaders, physicians, and clinical experts to develop best practices, improve workflows, strengthen provider relationships, and support strategic initiatives that directly impact client and patient outcomes.

The schedule for the role is either 8:00am-5:00pm EST or 8:00am-5:00pm CST.

This is an excellent opportunity for someone who enjoys looking beyond day-to-day operations to identify opportunities for improvement, develop clinical guidelines, and help build scalable processes that support organizational growth.

What makes someone successful in this role?

• Experience within the PIP, No-Fault, Workers' Compensation, or managed care industry
• Prior leadership or management experience
• A track record of developing or improving operational processes and clinical programs
• Strong knowledge of utilization review and regulatory compliance
• The ability to collaborate across teams and influence positive change

Responsibilities may include:

• Oversee departmental operations to ensure services are delivered effectively and in compliance with all regulatory requirements, company policies, and HIPAA standards.
• Ensure daily workflow is managed efficiently and adjust as necessary to achieve quality, productivity, and service goals.
• Maintain control of operating expenses and resources to support departmental and organizational objectives.
• Create and provide support, training, tools, and resources to assist staff in achieving departmental excellence and maintaining company standards.
• Review and analyze quality assurance and performance data and implement improvement strategies to enhance quality, consistency, and productivity.
• Serve as the department's clinical subject matter expert regarding treatment trends, industry best practices, and regulatory requirements.
• Maintain knowledge of New Jersey AICRA and Michigan PIP regulations and ensure operational processes align with applicable requirements.
• Collaborate with physician panel members and consulting clinical resources to support quality initiatives, clinical consistency, and program development.
• Monitor clinical and treatment trends and recommend process improvements and operational enhancements.
• Oversee and assist, as needed, with the resolution of provider appeals and escalated clinical issues.
• Organize and participate in staff meetings and promote effective communication across all lines of business.
• Respond promptly to customer service needs and resolve complex customer service situations.
• Ensure staff receives timely communication regarding client-specific requirements, operational changes, and special instructions.
• Ensure organizational activities and operations comply with applicable local, state, and federal laws and regulations.
• Perform other duties as assigned.

Qualifications

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 utilization review, clinical operations, and insurance-related healthcare services preferred. Knowledge of the insurance industry and no-fault (PIP), workers' compensation, liability, and disability claims environments preferred.

QUALIFICATIONS

• Active unencumbered Registered Nursing license required.
• Must possess strong knowledge of medical terminology, anatomy and physiology, medications, laboratory values, and evidence-based treatment practices.
• Must possess general knowledge of automobile claims regulations as they relate to No-Fault (PIP) programs and utilization review practices. Detailed knowledge of New Jersey AICRA and Michigan PIP regulations is preferred.
• Must possess working knowledge of nationally recognized treatment guidelines and evidence-based clinical review resources utilized in utilization review operations.
• Must possess a working knowledge of medical records, health information principles, and medical-legal documentation.
• Must possess strong analytical skills and the ability to evaluate operational, quality, and productivity data to support departmental goals and performance outcomes.
• Must demonstrate strong critical thinking, clinical judgment, and decision-making abilities.
• Ability to follow instructions and respond appropriately to management direction.
• Must be proficient in Microsoft Word, Outlook, Excel, Internet applications, and other business-related software programs.
• Must be able to operate standard office equipment, including computer, copier, scanner, and telephone.
• Must possess excellent verbal, written, and interpersonal communication skills.
• Must be able to effectively communicate and collaborate with physicians, healthcare providers, clients, and internal stakeholders.
• Must demonstrate accuracy, thoroughness, accountability, and a commitment to quality while identifying opportunities for continuous improvement.
• Must exercise sound judgment, make informed decisions, and appropriately involve others in the decision-making process.
• Must be able to work independently, prioritize responsibilities, and manage multiple competing priorities.
• Must possess strong analytical and problem-solving skills, including the ability to evaluate clinical, operational, and quality-related information and implement effective solutions.
• Must maintain confidentiality and handle sensitive information appropriately.
• Must be able to foster and promote a positive, team-oriented work environment.
• Must be able to remain focused and productive in a fast-paced environment with frequent interruptions.
• Must be able to perform effectively under pressure and meet established deadlines.
• Must be able to adapt to changing priorities, manage change effectively, and respond appropriately to unexpected situations.
• Ability to follow all company policies and procedures in effect at time of hire and as amended.

ExamWorks is a leading provider of innovative healthcare services including independent medical examinations, peer reviews, bill reviews, Medicare compliance, case management, record retrieval, document management and related services. Our clients include property and casualty insurance carriers, law firms, third-party claim administrators and government agencies that use independent services to confirm the veracity of claims by sick or injured individuals under automotive, disability, liability and workers' compensation insurance coverages.

ExamWorks, LLC is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws.

Equal Opportunity Employer - Minorities/Females/Disabled/Veterans

ExamWorks offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k.