Clinical Operations Manager

ExamWorks

. Oversee departmental operations to ensure effective, compliant service delivery under regulatory requirements, company policies, and HIPAA standards .

Posted 10/22/2026full-timeRemote • New Jersey • United StatesMid-LevelSenior💰 $100,000 - $120,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in clinical operations management, regulatory compliance, and quality assurance within healthcare settings. Proficient in utilizing analytical skills to enhance service delivery and operational efficiency while maintaining adherence to HIPAA standards and state regulations.

Highest-signal resume keywords

Clinical Operations ManagementRegulatory ComplianceQuality AssuranceLeadership ExperienceUtilization Review

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Clinical JudgmentMedical TerminologyAnatomy and PhysiologyEvidence-Based Treatment PracticesDecision-MakingProblem-SolvingUtilization Review PracticesMedical Records ManagementHealth Information PrinciplesMicrosoft Office Suite

Soft Skills

Analytical SkillsCommunication SkillsCollaborationAdaptabilityConfidentiality

Tools & Technologies

Business-Related SoftwareInternet ApplicationsStandard Office Equipment

Certifications & Qualifications

Registered Nursing License

Industry Keywords

PIPNo-FaultWorkers' CompensationManaged CareHealthcare AdministrationClinical Subject Matter ExpertTreatment TrendsQuality InitiativesOperational EnhancementsCustomer Service

About the role

Key responsibilities & impact

Oversee departmental operations to ensure effective, compliant service delivery under regulatory requirements, company policies, and HIPAA standards
Manage daily workflows and adjust operations to achieve quality, productivity, and service goals
Control operating expenses and resources to support departmental and organizational objectives
Provide staff support, training, tools, and resources
Review and analyze quality assurance and performance data and implement improvement strategies
Serve as the department's clinical subject matter expert on treatment trends, industry best practices, and regulatory requirements
Maintain knowledge of New Jersey AICRA and Michigan PIP regulations and align operational processes accordingly
Collaborate with physician panel members and consulting clinical resources on quality initiatives, clinical consistency, and program development
Monitor clinical and treatment trends and recommend process improvements and operational enhancements
Oversee and assist with provider appeals and escalated clinical issues
Organize and participate in staff meetings and promote communication across lines of business
Respond to customer service needs and resolve complex customer service situations
Communicate client-specific requirements, operational changes, and special instructions to staff
Ensure activities and operations comply with applicable local, state, and federal laws and regulations
Perform other duties as assigned

Requirements

What you’ll need

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 experience
Experience in PIP, No-Fault, Workers' Compensation, or managed care industry
Prior leadership or management experience
Experience in utilization review, clinical operations, and insurance-related healthcare services preferred
Active unencumbered Registered Nursing license required
Strong knowledge of medical terminology, anatomy and physiology, medications, laboratory values, and evidence-based treatment practices
General knowledge of automobile claims regulations related to No-Fault (PIP) programs and utilization review practices
Working knowledge of nationally recognized treatment guidelines and evidence-based clinical review resources
Working knowledge of medical records, health information principles, and medical-legal documentation
Strong analytical, critical thinking, clinical judgment, decision-making, problem-solving, and communication skills
Proficiency in Microsoft Word, Outlook, Excel, Internet applications, and other business-related software
Ability to operate standard office equipment
Ability to collaborate with physicians, healthcare providers, clients, and internal stakeholders
Ability to work independently, prioritize responsibilities, and manage multiple competing priorities
Ability to maintain confidentiality and handle sensitive information appropriately
Ability to work effectively under pressure, meet deadlines, adapt to changing priorities, and manage unexpected situations
Ability to follow company policies and procedures

Benefits

Comp & perks

Medical, vision, and dental benefits
Paid time off
401k
Fully remote work