Remote Clinical Operations Leader (PIP/UR)

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

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.