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