Clinical Operations Manager
Our story
At Alight, we believe a company's success starts with its people. At our core, we Champion People, help our colleagues Grow with Purpose and true to our name we encourage colleagues to "Be Alight."
Our Values:
A - Agile
L - Leadership
I - Integrity
G - Growth Mind Set
H - High Quality
T - Trust
It's why we're so driven to connect passion with purpose. Our team's expertise in human insights and cloud technology gives companies and employees around the world the ability to power confident decisions, for life.
With a comprehensive total rewards package, continuing education and training, and tremendous potential with a growing global organization, Alight is the perfect place to put your passion to work.
Join our team if you Champion People, want to Grow with Purpose through acting with integrity and if you embody the meaning of Be Alight.
Learn more at careers.alight.com.
About the Role
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 asst in training of all clinical protocols and best practices used by our absence management clinical staff, including Registered Nurses, and Vocational Rehabilitation Counselors. The Clinical Operations Manager will serve as a Senior Clinical reviewer for highly complex, high-profile escalated claims.
You will
- Manage a team of clinical case managers (CCM's)
- Lead, motivate, and develop assigned clinical case manager staff
- Assess and monitor clinical case manager's workload capacity and efficiency
- Assess and measure staff performance and set appropriate goals
- Perform mid-year and annual performance evaluations, communicating expectations, goals, deadlines and team results
- Monitor and control personnel issues of clinical claim managers and work directly with Human Resources as needed
- Coordinate with other clinical operations managers to provider clinical case management support across Alight's book of business.
- Conduct clinical audits and provide feedback and mentoring, coordinate with clinical leaders on corrective actions as applicable
- Support operations claim teams by monitoring and resolving escalated customer complaints related to clinical issues
- Participate in the reinforcement of return-to-work best practice protocols and workflows
- Occasionally assist with overflow of clinical reviews upon request of manager
- Perform side by side listening/shadowing and coaching with team members to assist in further development of clinical staff.
- Collaborate with senior clinical reviewer for highly complex high-profile disability claims and/or escalated claims.
- Conduct regular clinical round tables to determine level of functional impairment based on knowledge of medical signs and symptoms and the employer's essential job functions and reinforce methodology of reviewing claims based on best practice case review per medical disability guidelines review protocol.
You have
- Bachelor's degree or equivalent experience.
- Overall experience of 8+ year
- RN license
- 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 or mentorship skills
- Advanced problem-solving and analytical skills
- Excellent communication (written/verbal) and relationship building skills
- Superior ability to work in a team setting
- Ability to communicate complex information in a mentoring/training situation
- Strong organization skills, time management and follow-through are essential
- Strong presentation skills
- Ability to work in evening/night shift
Benefits
Not included in the source posting: about the role, what you'll do, qualifications.
Skills
Who can apply
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