Remote Clinical Operations Manager (PIP/UM Focus)

IME RESOURCES LLC; Mount Laurel Township (NJ); À distance; USD 100 000 - 120 000; Plein temps

Résumé du poste

ExamWorks is seeking a Clinical Operations Manager to lead our clinical programs and manage a high-performing remote team. This 100% fully remote position provides clinical leadership across utilization management and No-Fault (PIP) programs, ensuring services are delivered efficiently, compliantly, and with high quality.

You will partner with operational leaders, physicians, and clinical experts to develop best practices, improve workflows, strengthen provider relationships, and support

Qualifications

• Active RN license required.
• Minimum of six years related clinical experience, including at least three years in leadership or management.
• Experience in utilization review, clinical operations, and insurance-related healthcare services preferred.
• Knowledge of NJ AICRA and Michigan PIP regulations is preferred.

Responsabilités

• 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.

Connaissances

Clinical leadership

Utilization review

No-Fault/PIP

Regulatory compliance

Team mentoring

Formation

Registered Nursing license

Bachelor's degree in nursing or healthcare administration

Outils

Microsoft Word

Microsoft Excel

HIPAA compliance tools

Description du poste

ExamWorks is seeking a Clinical Operations Manager to lead our clinical programs and manage a high-performing remote team. This 100% fully remote position provides clinical leadership across utilization management and No-Fault (PIP) programs, ensuring services are delivered efficiently, compliantly, and with high quality.

You will partner with operational leaders, physicians, and clinical experts to develop best practices, improve workflows, strengthen provider relationships, and support