[Hiring] Clinical Operations Manager @VetJobs

Role Description

ATTENTION MILITARY AFFILIATED JOB SEEKERS

• Our organization works with partner companies to source qualified talent for their open roles.
• This position is available to Veterans, Transitioning Military, National Guard and Reserve Members, Military Spouses, Wounded Warriors, and their Caregivers.
• This role is remote in the US, but does not hire from PR, AK, HI or CA. This is not open to any OCONUS locations.

This role owns the function as a strategic remit from day one: building and leading the medical certification review (clinical) team, standardizing how the team operates, and setting the roadmap for the function's expansion.

Here’s What You’ll Do:

• Clinical Operations Leadership
  • Own end-to-end clinical review of medical certifications submitted in support of leave requests.
  • Oversee day-to-day clinical operations, including intermittent leave analysis and extension evaluations.
  • Manage the medical certification team, including hiring, coaching, and performance management.
  • Serve as the clinical escalation point for disputed certifications.
  • Support cross-functional execution across Product, Legal, Compliance, and CX.
  • Resolve operational issues and remove bottlenecks that slow clinical review throughput.
• Process & Systems Development/Improvement
  • Build and improve operational workflows so outcomes are consistent.
  • Create and update SOPs and documentation-sufficiency standards.
  • Manage operational systems and reporting, and maintain documentation trails.
  • Identify trends across certification reviews and translate them into continuous operational improvements.
• Compliance & Administration
  • Own clinical consistency and compliance oversight for the function.
  • Manage licensing and credentialing for the clinical team.
  • Support broader compliance initiatives and coordinate insurance and regulatory requirements.
  • Partner with Compliance leadership on escalated and legally sensitive cases.
• Leadership & Planning
  • Meet regularly with department leaders to align on operational priorities and performance.
  • Review operational performance and quality-assurance results.
  • Set performance standards and design training curricula for clinical reviewers.
  • Plan future operational improvements and own the roadmap for expanding the function.
  • Develop and facilitate ongoing education for Leave Specialist team.

Qualifications

• Strong knowledge of FMLA, ADA, and state paid-leave/disability laws as they apply to clinical certification standards.
• 3+ years experience in disability, leave-of-absence, or claims-related clinical review.
• RN license strongly preferred; in lieu of licensure, significant utilization review experience within an insurance company, TPA, or leave-management environment will be considered.
• Direct experience managing a care team with expertise in Short & Long-Term Disability, Family & Medical Leave Administration, and ADA Accommodations.
• 3+ years of people-management experience.
• Experience designing or standardizing operational workflows, SOPs, or training programs.
• Strong cross-functional collaborator with comfort partnering with Compliance, Legal, Finance, CX, and Product as a peer.
• Comfortable with ambiguity; this role is building a new function, not maintaining an existing one.
• Certified Case Manager (CCM) or similar credential a plus.
• URAC/NCQA accreditation experience a plus.
• Prior experience at a leave/disability carrier or TPA (e.g., Sedgwick, Unum, Lincoln Financial, The Standard, Reliance Standard) a plus.

Requirements

• Strong knowledge of FMLA, ADA, and state paid-leave/disability laws as they apply to clinical certification standards.
• 3+ years experience in disability, leave-of-absence, or claims-related clinical review.
• RN license strongly preferred; in lieu of licensure, significant utilization review experience within an insurance company, TPA, or leave-management environment will be considered.
• Direct experience managing a care team with expertise in Short & Long-Term Disability, Family & Medical Leave Administration, and ADA Accommodations.
• 3+ years of people-management experience.
• Experience designing or standardizing operational workflows, SOPs, or training programs.
• Strong cross-functional collaborator with comfort partnering with Compliance, Legal, Finance, CX, and Product as a peer.

Benefits

• This is a full-time, exempt position.
• Compensation ranges from $111,250-$159,500 based on experience and your legal state of residence.