The Sr. Clinical Operations Manager oversees the activities of a team of clinical case managers which may include registered nurses, nurse practitioners, behavioral health and vocational rehab counselors supporting STD, FMLA, and LTD. The primary function in this role is to ensure clinicians provide efficient and effective clinical case manager services within compassionate care philosophy. In this role the Clinical Manager monitors staffing ratios, provides clinical case manager training and mentoring, and leads the hiring of new clinician candidates. In addition, the Clinical Operations Manager collaborates with Claim Operation Managers on account specific clinical issues as needed and ensures that clinicians meet or exceed applicable performance guarantees specific to ReedGroup clients.
You have
Superior Clinical Case manager skills and ability to serve in a leadership role
Strong analytic skills
Advanced problem-solving and analytical skills
Strong written and verbal communication 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 Excellent communication and relationship building skills
About ReedGroup
As the largest exclusive provider of absence management services, ReedGroup has been dedicated to helping employees return to work safely for more than 35 years. We create a seamless experience so clients can excel at their jobs and better serve their employees - supporting a thriving, engaged, and skilled workforce.
ReedGroup is a wholly-owned, independent subsidiary of The Guardian Life Insurance Company - providing even more ways we can better serve people. Guardian has been helping people protect their futures and secure their lives for more than 150 years, and today serves 27 million people by helping them find financial confidence and well-being in life, health, and wealth. And as one of the largest mutual insurance companies, we know what matters most: putting the needs of customers first.
Equal Employment Opportunity
Reed 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.Required Qualifications
A minimum of 3 years of clinical health care experience
A minimum of 5 years of disability claims experience
At least a bachelor's degree in nursing or related field or comparable advanced degree in medical field,
e.g., Master of Science in Nursing.
Unrestricted state clinical licensure
Desired Qualifications
Supervisor experience in disability industry or related managed care industry.
Holds an industry applicable certification/designation, e.g., CCM, CDMS, ADM, COHN, etc.
Advanced Business Degree, e.g., master's in business, Master's in Public Health Administration, etc.
You will
Adapt to changing business priorities and environments.
Assess and monitor clinical case managers' workload capacity and efficiency.
Assess staff performance and measures staff performance and set appropriate goals.
Be a positive, energetic and results oriented team player
Conduct clinical audits and provide feedback and mentoring to direct reports.
Coordinate with the other Clinical Operations Managers to provide clinical case management
support across ReedGroup book of business.
Create and maintain a collaborative team focused on effective, high quality client service
Demonstrate adherence to Reed Group values and performance guidelines
Demonstrate experience leading, mentoring and inspiring staff to achieve superior results
Develop solutions and recommend appropriate action to prevent recurrence of problem
Excel in managing complex client relationships involving clinical services
Focus on building talent and people capability to enable a high-performance culture
Identify opportunities for continuous improvement
Lead, motivate, and develop assigned clinical case manager staff by conducting regular clinical team meetings
and other clinical team members as later determined by manager.
Manage multiple projects with multiple deliverables simultaneously.
Manage to the established Key Performance Indicators (KPI's) and ensure Performance Guarantees are met
Monitor and control personnel issues of clinical claim mangers and work directly with Human Resources as needed
Monitor team for productivity and quality client service
Occasional assist with overflow of clinical reviews upon request from manager.
Oversee and/or develop clinician performance metrics to assess efficiency of clinician activities.
Participate appropriately in client meetings and implementations
Participate in Finalist meetings as requested.
Participate in retention, recruitment, and termination activities related to clinical case manager staff as needed.
Participate in scheduled meetings with the Clinical Directors/Medical Director regarding staffing, training,
and quality assurance initiatives.
Participate in the reinforcement of return-to-work best practice protocols and workflows.
Perform annual performance evaluations, communicating expectations, goals, deadlines, and team results.
Perform side by side listening/shadowing and coaching with team members to assist in the further development
of clinical staff
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 re-training.
Provide insight on direct report's clinical audit trends and coordinate with clinical leaders on corrective
actions as applicable.
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
Respond timely and accurately to client and internal inquiries, according to established standards with
attention to style, tone, and manner of communication
Serve a vital role in coaching the team and being the escalation point for complex incidents
Serve as the liaison between the Director and the team
Support operations claim team by monitoring and resolving escalated customer complaints related to clinical issues.
Support sales team by participating in finalist presentations
Upon account requirements and upper management request, visit clients for new account implementation
and maintenance of existing accounts.
Upon request, assist in the develop and/or enhancement of clinical case management best practices.
Reporting Relationships
As a Sr. Clinical Operations Mangers, you will report to our Chief Medical Officer, who reports to our Chief Executive Officer.
Location
Remote work with occasional travel to ReedGroup offices post-pandemic will be required.
Travel
Some travel 3 - 5%
Ability to travel to claim operations sites as needed.
Ability to travel to client meetings, as needed.
Attend client meetings for new account implementation and maintenance of existing accounts, as needed.
Nights and weekend work occasionally.
Sedentary Work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time.
Guardian has been helping people protect their futures and secure their lives for more than 160 years. Every day, we serve approximately 27 million people through a range of insurance and financial products. As one of the largest mutual insurance companies, we know what matters most: putting the needs of our customers first. Because everyone deserves a Guardian. Learn more about Guardian at guardianlife.com
Guardian 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.
