Clinical Operations Manager - Virtual Care Management (RN)

Accountabilities:

• Lead daily care navigation operations, including case assignment, prioritization, aging, closure, and accountability for patient cases from initiation through resolution.
• Establish and enforce workflow standards for time-sensitive activities such as returned results, clinical rechecks, provider order follow-up, returned faxes, and referrals.
• Set production expectations, caseload capacity, and turnaround-time standards by task type while monitoring queue health and reallocating work before backlogs develop.
• Define clear responsibilities and escalation pathways across RNs, care navigation specialists, clinical leads, and supervisors.
• Oversee longitudinal chronic care management operations, including care plan development, patient outreach cadence, and documentation completeness.
• Manage daily execution of 24/7 nursing coverage, including shift handoffs, overnight production expectations, weekend and holiday rotations, and minimum staffing requirements.
• Ensure inbound patient calls are answered and clinically triaged appropriately across all operating hours, including rollover coverage from adjacent teams.
• Partner with clinical leadership on scope-of-practice requirements, triage protocols, and escalation processes involving providers.
• Lead remote therapeutic monitoring operations through medical assistants and licensed practical nurses conducting proactive outreach, medication adherence monitoring, and interventions.
• Manage ratio-based caseload models, assigning and rebalancing patient panels as census changes and escalating staffing needs when growth exceeds workforce plans.
• Ensure clinical concerns are promptly escalated to nursing and provider teams while maintaining required documentation and billing standards for monitoring services.
• Execute published staffing plans across caseload-based, coverage-based, and 24/7 operating models, making real-time staffing decisions when circumstances change.
• Manage schedule adherence, shift swaps, same-day absences, and planned overtime while escalating structural coverage needs to workforce operations.
• Participate in interviewing, selection, and onboarding while identifying staffing gaps early enough to support timely hiring.
• Build and maintain operational reporting covering throughput, case aging, schedule adherence, census, and quality, using the data to drive workflow decisions.
• Coach and develop supervisors and clinical leads in performance management, documentation, accountability, and team leadership.
• Partner with quality and compliance teams to meet clinical, HIPAA, and health plan contractual requirements, including audits and gap-closure activities.
• Contribute to workflow design, SOP development, testing, training, and operational implementation as programs, health plan partnerships, and platform capabilities evolve.
• Lead, develop, and hold supervisors accountable while building bench strength and maintaining clear role boundaries between leads and supervisors.
• Monitor team turnover and actively address retention through onboarding, workload management, scheduling practices, career development, and frontline leadership quality.
• Promote employee satisfaction, engagement, connection, visibility, and recognition across remote teams.

Requirements

• Active, unrestricted RN license with direct patient care experience; multi-state or compact licensure is preferred.
• Experience in a virtual care practice or healthcare contact center environment, including telehealth, care management, disease management, population health, or similar operations.
• At least 3 years of people leadership experience, including management of supervisors or team leads in a clinical or production operations setting.
• Demonstrated ability to manage multiple concurrent workflows involving distinct teams, queues, programs, deadlines, and operating requirements.
• Experience managing caseload- or panel-based work while holding teams accountable for throughput and turnaround-time standards.
• Experience managing coverage, schedule adherence, and real-time staffing decisions against established staffing plans.
• Demonstrated success with employee retention and reducing attrition, ideally within a remote or high-volume healthcare environment.
• Strong data fluency, including the ability to build and interpret operational reports, Excel analyses, and dashboards and translate findings into action.
• Proficiency with EHR and practice management systems, telehealth platforms, care management documentation tools, and CRM systems.
• Strong understanding of HIPAA, patient privacy, and healthcare compliance obligations in a remote environment.
• Availability to support 24/7 operations, including rotating weekend and holiday escalation coverage.
• Bachelor of Science in Nursing, or a bachelor’s degree in healthcare administration, business, or a related discipline, preferred.
• Direct experience with CCM, APCM, RPM, or RTM program operations, including documentation and billing requirements, preferred.
• Experience supporting Medicare Advantage, Medicare Part D, or delegated health plan programs, including quality measures and gap closure initiatives such as HEDIS, Star Ratings, or SUPD, preferred.
• Experience developing or restructuring 24/7 coverage models is beneficial.
• Experience in a high-growth or rapidly scaling healthcare organization is preferred.
• Strong follow-through and accountability, with a focus on ensuring work is fully completed and documented.
• Ability to manage several unrelated workstreams simultaneously without losing focus on deadlines or outcomes.
• Ability to communicate credibly with clinical teams while also operating effectively with senior and executive stakeholders.
• Highly self-directed, organized, and effective in a remote environment.
• Strong inclination toward documenting, standardizing, and simplifying manual or informal processes.
• Must be able to perform all work physically within the United States; international work during scheduled work hours is not permitted.

Benefits

• Fully remote position within the United States.
• Full-time, exempt employment.
• Leadership opportunity overseeing supervisors and multiple virtual care operations.
• Opportunity to shape care navigation, chronic care management, remote therapeutic monitoring, and 24/7 clinical operations.
• Exposure to clinical operations, workforce management, quality, compliance, and healthcare program development.
• Opportunity to contribute to process improvement, SOP development, training, and scalable operational models.
• Home-office environment with flexibility inherent to remote work.
• Secure, private workspace and reliable high-speed internet required.
• Computer equipment must be a Windows or Apple macOS device; Chromebooks, Linux machines, and smartphones are not permitted for work.
• Minimum computer requirements include Windows 10 or later or macOS 14 Sonoma or later, Intel Core i5/AMD equivalent or Apple Silicon, and 16 GB RAM.
• Wired headphones with an external or dedicated microphone are required.
• Minimum internet requirements of 100 Mbps download and 50 Mbps upload, with a direct Ethernet connection from the computer to the router.
• Google Chrome and Amazon Workspaces are required.
• Webcam required for video calls; built-in laptop webcams are acceptable.
• A second monitor is strongly recommended for laptop users, with dual monitors suggested for PC users.