Remote Clinical Operations Lead (PIP/No-Fault)

ExamWorks, Inc.; United States; Remote; USD 110,000 - 160,000; Full time

Job summary

ExamWorks, Inc. is seeking a Clinical Operations Manager to lead remote teams overseeing utilization management and No-Fault (PIP) programs.

You will shape clinical programs, develop best practices, and collaborate with physicians and clinical experts to improve workflows and provider relationships in a fully remote, nationwide setting. The role emphasizes identifying opportunities for process improvement, building scalable processes, and ensuring compliant, high-quality service delivery across

Qualifications

• Active Registered Nursing license required.
• 6 years clinical experience including at least 3 years in leadership/management.
• Experience in utilization review, clinical operations, and insurance-related healthcare services preferred.
• Knowledge of New Jersey AICRA and Michigan PIP regulations preferred.

Responsibilities

• Oversee departmental operations to ensure compliant, efficient service delivery.
• Manage daily workflow to meet quality, productivity, and service goals.
• Control operating expenses and resources to support objectives.
• Provide staff training, tools, and resources for excellence.
• Review quality data and implement improvement strategies for quality and productivity.
• Serve as clinical SME on treatment trends and regulatory requirements.
• Collaborate with physicians and resources to support quality initiatives.
• Monitor clinical trends and propose process improvements.
• Assist with resolving provider appeals and escalated clinical issues.
• Promote effective communication across lines of business.

Skills

PIP/No-Fault experience

Leadership experience

Operational processes improvement

Utilization review knowledge

Regulatory compliance knowledge

Collaboration across teams

Clinical subject matter expertise

Microsoft Word

Microsoft Excel

Outlook

Education

Bachelor's degree

Tools

Microsoft Word

Microsoft Excel

Outlook

Job description

ExamWorks, Inc. is seeking a Clinical Operations Manager to lead remote teams overseeing utilization management and No-Fault (PIP) programs.

You will shape clinical programs, develop best practices, and collaborate with physicians and clinical experts to improve workflows and provider relationships in a fully remote, nationwide setting. The role emphasizes identifying opportunities for process improvement, building scalable processes, and ensuring compliant, high-quality service delivery across