Clinical Operations Manager
Company: Guardian Life
Location: Raleigh
Posted on: January 25, 2023
Job Description:
The Clinical Operations Manager will manage the activities of a
team of clinical case managers supporting STD, FMLA and LTD. Also,
the Clinical Operations Manager will provide oversight and assist
in training of all clinical protocols and best practices used by
our Absence Management clinical staff, including Registered Nurses,
Nurse Practitioners and Vocation Rehabilitation Counselors. The
Clinical Operations Manager will serve as a Senior Clinician
Reviewer for highly complex, high profile escalated claims.You
have
- RN, LVN/LPN, Licensed counselor, psychologist and/or related
field
- 1-3 years minimum of clinical experience
- Minimum of 5 years of experience in disability management
and/or managed care
- 2+ years of supervisory experience
- Unrestricted state clinical licensure
- Superior clinical case manager skills and eagerness to function
in a leadership role
- Strong teaching and mentoring skills
- Advanced problem-solving and analytical skills
- Excellent communication (written/verbal) and relationship
building skills
- Comprehensive knowledge of disability concepts, disability
products, medical terminology, and claim management practices and
principles
- Thorough knowledge of STD, FMLA, LTD claim procedures
- Superior ability to work in a team setting
- Ability to communicate complex information in a
mentoring/training situation
- Exceptional customer service delivery style to both internal
and external customers
- Strong organization skills, time management and follow through
are essential
- Ability to manage multiple projects
- Strong presentation skills (i.e., public speaking)
- The proven ability to manage both day-to-day execution and
projects to achieve results of business goals and special
assignments
- Advanced level computer skills using Windows 2000 and Microsoft
Office suite of programs including Word, Excel, PowerPoint and
Outlook
- A masters degree in nursing e.g., Master of Science in Nursing,
or related health care preferred
- Manager experience in disability or managed care industry
preferred
- An industry applicable certification/designation preferred,
e.g., CCM, CDMS, ADM, COHN, etc.
- Advanced business degree preferred, e.g., Masters in Business,
Masters in Public Health Administration, etc.You will
- Manage a team of clinical case managers (CCMs)
- Lead, motivate, and develop assigned clinical case manager
staff
- Assess and monitor clinical case managers workload capacity and
efficiency
- Assess and measure staff performance and set appropriate
goals
- Perform annual performance evaluations, communicating
expectations, goals, deadlines, and team results
- Participate in retention, recruitment, and termination
activities related to clinical case manager staff
- Monitor and control personnel issues of clinical claim managers
and work directly with Human Resources as needed
- Coordinate with other clinical operations managers to provide
clinical case management support across ReedGroups book of
business
- Conduct clinical audits and provide feedback and mentoring,
coordinate with clinical leaders on corrective actions as
applicable
- Support operations claims team by monitoring and resolving
escalated customer complaints related to clinical issues
- Upon account requirements and upper management request, visit
clients for new account implementation and maintenance of existing
accounts
- Participate in the reinforcement of return-to-work best
practice protocols and workflows
- Occasionally assist with overflow of clinical reviews upon
request of manager
- Upon request, assist in the development and/or enhancement of
clinical case management best practices
- Oversee and/or develop clinician performance metrics to assess
efficiency of clinician activities
- Manage multiple projects with multiple deliverables
simultaneously
- Provide clinical oversight and coordination with appeals
managers on quality assurance related to Appeal Unit decisions
related to internal clinician reviews to address opportunities for
process improvement or clinician retraining
- Adapt to changing business priorities and environments
- Demonstrate experience leading, mentoring, and inspiring staff
to achieve superior results
- Focus on building talent and people capability to enable a
high-performance culture
- Perform side by side listening/shadowing and coaching with team
members to assist in further development of clinical staff
- Provide ongoing client support with the use of diagnostic
skills to identify root cause of client issues, develop solutions
and recommend appropriate action to prevent recurrence of
problem
- Provide weekly updates to management on clinical team
progress
- Serve as a Senior Clinician Reviewer for highly complex, high
profile disability claims and/or escalated claims
- Conduct regular clinical round table to determine level of
functional impairment based on knowledge of medical signs and
symptoms and the employees essential job functions and reinforce
methodology of reviewing claims based on best practice case review
per Medical Disability Guidelines review protocol
- Coordinate a strategy to clarify employee level of
functionality and resolve inconsistencies noted in clinical
information submitted for review
- Identify barriers for employees to return to work as well as
identify appropriate (optimal) health care, rehabilitation, and
work to facilitate an early and safe return to work
- Provide guidance to claim staff for need for referral to
Medical Review services, e.g., physician round tables, formal peer
review, and IME and/or FCE referrals
- As needed, supplement CCMs by providing clinical review support
to disability claim managers when overflow is experienced
- Communicate effectively with health care providers, employees,
and employers if applicable
- Education & Training
- Provide oversight of the continuing clinical education,
certification, and licensure of direct reports, e.g., CDMS, CCM,
ADMS, state licensure status and costs
- Reinforce Clinical Model Advocacy philosophy whereby
reinforcing provider outreaches for functional capacity
clarification by clinicians and contacting employee as needed to
clarify functional capacity and transitional work opportunities as
applicable
- Account Relations
- Oversee and/or participate in client implementations regarding
program performance where clinical enhancements and subsequent
training of clinical staff may be needed
- Consult with Claim Operations Managers and/or CCMs on clinical
case management strategies for unique scenarios which may or may
not trigger the need to revise our best practice protocols
- Consult with clients on clinical and RTW program development as
requested by Operations managers in coordination with ReedGroup
Account ManagerLocation
- Remote WFH FlexibilityTravel
- 3-5% - ability to travel to claim operations sites and client
meetings as needed
- Nights and weekend work occasionallyOur PromiseAt ReedGroup,
youll have the support and flexibility to achieve your professional
and personal goals. Through skill-building, leadership development
and philanthropic opportunities, we provide opportunities to build
communities and grow your career, surrounded by diverse colleagues
with high ethical standards.Inspire Well-BeingAs part of ReedGroups
Purpose to inspire well-being we are committed to offering
contemporary, supportive, flexible, and inclusive benefits and
resources to our colleaguesHealth Care
- Choice of [high deductible/copay] medical plans* with
prescription drugs, including coverage for fertility and
transgender inclusive benefits
- Dental plan
- Vision plan
- Health care accounts flexible spending, health reimbursement,
and health savings accounts
- Critical illness insuranceLife and Disability Insurance
- Company-paid Life and Disability insurance plus voluntary
supplemental coverage
- Accident insuranceRetirement and Financial
- 401(k) retirement plan with a company match, plus an annual
age/service-based Company contribution and an annual profit-sharing
contribution, if applicable
- Complimentary 1:1 financial guidance with a licensed Fidelity
representativeTime Off and Remote Work
- Flexible work arrangements (part in-person/part remote)
- Unlimited paid time off for most roles plus time off for
volunteering, jury duty, voting, and bereavement
- Personal holidays for colleagues to use in recognition of
religious, cultural, or civic days
- Paid parental leave and paid family and medical leave
policiesEmotional Well-being and Work-Life
- Emotional well-being, mental health, and work/life resources
powered by Spring Health
- Wellness programs, including fitness program and equipment
reimbursement
- Child, adult, and elder back-up care support through Bright
Horizons
- Adoption assistance
- College planning
- Tuition reimbursement
- Student loan assistance
- Commuter benefits in select metropolitan areasJustice, Equity,
Diversity & Inclusion (J.E.D.I.)
- Employee Resource Groups that advocate for inclusion and
diversity
- J.E.D.I. certification and training programs
- Matching gifts/volunteeringBenefits apply to full-time eligible
employees. Interns are not eligible for most Company benefits.Equal
Employment OpportunityReedGroup is an equal opportunity employer.
All qualified applicants will be considered for employment without
regard to age, race, color, creed, religion, sex, affectional or
sexual orientation, national origin, ancestry, marital status,
disability, military or veteran status, or any other classification
protected by applicable law.ReedGroup is committed to providing
access, equal opportunity and reasonable accommodation for
individuals with disabilities in employment, its services,
programs, and activities. If reasonable accommodation is needed to
participate in the job application or interview process, to perform
essential job functions, and/or to receive other benefits and
privileges of employment, please contact
applicant_accommodation@glic.com .Every day, Guardian helps our 29
million customers realize their dreams through a range of insurance
and financial products and services. Our Purpose, to inspire
well-being, guides our dedication to the colleagues, consumers, and
communities we serve. We know that people count, and we go above
and beyond to prepare them for the life they want to live, focusing
on their overall well-being mind, body, and wallet. As one of the
largest mutual insurance companies, we put our customers first.
Behind every bright future is a GuardianTM. Learn more about
Guardian at guardianlife.com .
Keywords: Guardian Life, Raleigh , Clinical Operations Manager, Executive , Raleigh, North Carolina
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