Clinical Operations Manager

Are you a clinical leader with experience in PIP, Workers' Compensation, utilization review, or managed care who enjoys improving processes, mentoring teams, and driving quality outcomes?

Exam Works is seeking a Clinical Operations Manager to play a key role in shaping and enhancing our clinical programs while leading a high-performing remote  this 100% fully remote position, you'll provide clinical leadership across utilization management and No-Fault (PIP) programs, helping ensure services are delivered efficiently, compliantly, and with the highest level of quality. You'll partner with operational leaders, physicians, and clinical experts to develop best practices, improve workflows, strengthen provider relationships, and support strategic initiatives that directly impact client and patient outcomes.

The schedule for the role is either 8:00am-5:00pm EST or 8:00am-5:00pm CST.This is an excellent opportunity for someone who enjoys looking beyond day-to-day operations to identify opportunities for improvement, develop clinical guidelines, and help build scalable processes that support organizational growth.

What makes someone successful in this role?

Experience with in the PIP, No-Fault, Workers' Compensation, or managed care industry

Prior leadership or management experienceA track record of developing or improving operational processes and clinical programs

Strong knowledge of utilization review and regulatory compliance

The ability to collaborate across teams and influence positive change

Responsibilities may include:

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.

If you're looking for an opportunity to make a meaningful impact while working remotely for a growing organization, we'd love to connect with you.

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; or equivalent combination of education and…