[Hiring] Clinical Operations Manager, Utilization Review @Dane Street, LLC

Role Description

The Operations Manager drives Dane Street’s Group Health division by aligning daily operational leadership with clinical excellence in a high-volume, fast-paced environment. This role exists to ensure the seamless execution of utilization and independent clinical reviews by providing hands-on direction, capacity management, and clinical guidance to a multidisciplinary team of UR Nurses, QA Specialists, and Customer Service Representatives.

• Lead day-to-day operations for the assigned Group Health division, ensuring appropriate workflow, staffing, prioritization, and timely completion of work.
• Oversee Utilization Review Nurses, Clinical Quality Assurance Specialists, Customer Service Representatives, and other assigned operational staff.
• Manage the end-to-end operational workflow, including referral intake, clinical review preparation, quality assurance, client communication, and case completion.
• Serve as a clinical and utilization review subject matter resource for the team, providing guidance on clinical review workflows, utilization management principles, and complex or unusual case scenarios.
• Provide first-line support for clinical and process questions from clinical and non-clinical staff, escalating to Medical Director or senior clinical leadership when appropriate.
• Ensure operational and clinical processes align with client requirements, internal procedures, applicable regulatory requirements, and established utilization management workflows.
• Support new client implementations, volume expansions, and changes in client requirements.
• Lead the team through changing priorities, workflow demands, and business needs while maintaining service and quality expectations.

Qualifications

• Active, unrestricted Registered Nurse (RN) license required.
• Bachelor’s degree in Nursing, Healthcare Administration, Business Administration, or a related field preferred.
• Utilization Review/Utilization Management experience required.
• Healthcare operations leadership or people-management experience in a fast-paced, high-volume environment required.
• Demonstrated experience managing operational KPIs, including productivity, quality, turnaround time, and service-level performance required.
• Demonstrated ability to serve as a clinical and utilization management subject matter resource for clinical and non-clinical teams.
• Experience leading multidisciplinary teams that include clinical and non-clinical staff.
• Strong working knowledge of medical necessity review, utilization management principles, and healthcare payer operations.
• Experience coaching employees, managing performance, and developing high-performing teams.

Requirements

• Health plan, managed care, or payer experience strongly preferred.
• Experience with prior authorization, medical necessity review, appeals, and/or independent review services preferred.
• Experience managing remote teams preferred.
• Experience supporting client implementations, operational growth, or rapidly changing referral volumes preferred.

Benefits

• Collaborative remote culture.
• Professional growth opportunities.
• Meaningful work supporting the healthcare industry.
• Comprehensive benefits including medical, dental, and vision coverage for you and your family.
• Voluntary life insurance options for you, your spouse, and your children.
• Other voluntary benefits including hospital indemnity, critical illness, accident indemnity, and pet insurance plans.
• Basic life insurance, short-term disability, and long-term disability coverage at no cost.
• Generous paid time off policy.
• 401k plan with a company match.
• Apple equipment and a media stipend provided for remote workspace.