Manager, Clinical Operations

At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all our stakeholders - internal and external - driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and empower each other to illuminate our collective potential.

Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward!!!

JOB SUMMARY: This position is responsible for managing all facets of the Clinical Operations team, specializing in Quality and Testing for Claims Editing/Payment Integrity, including education, staffing, product evaluation and enhancement, and policies/procedures to ensure smooth and efficient operations.

JOB ROLES AND RESPONSIBILITIES:

• Manage the day-to-day Clinical Operations team including but not limited to the monitoring of individual and staff workload, operational productivity and performance, training, mentoring, motivating and management of workflows.
• Manage and track assigned department workload re-distributing as necessary.
• Implement robust testing procedures to ensure the functionality, integrity, accuracy, and quality of all modifications and enhancements to the editing logic, including:
  
  
  
  • Carefully analyzing clinical and technical requirements to clearly define the scope of testing.
  • Establishing, developing, and maintaining comprehensive test scenarios, data, checklists, and other essential documentation, all aligned with specific requirements.
  • Adopting best practices in software testing methodologies and techniques to guarantee optimal outcomes.
  
  
  
  
• Examine and resolve incorrect results, identify the root cause, and recommend solutions.
• Produce detailed, accurate documents in a consistent format that demonstrate strong analytical and documentation skills.
• Enhance test-based pre-production validation by effectively using post-production results and team feedback.
• Provide expert guidance and support to team members; serving as Subject matter Expert(SME)
• Effectively collaborate, coordinate and communicate across various disciplines and departments throughout the organization to resolve problems and ensure consistency and accuracy.
• Manage departmental performance to establish, meet, maintain and monitor metrics within turnaround time limits.
• Identify issues, problems, and opportunities, bring suggestions, and implement solutions to improve department's effectiveness and efficiency
• Complete and oversee special projects assigned by leadership.
• Create and distribute goals and standards to staff regularly.
• Participate in the development of policies and procedures based on current and future trends.
• Select, develop, and evaluate staff to ensure the efficient operation of department.
• Collaborate, coordinate, and communicate across disciplines and departments.
• Ensure compliance with HIPAA regulations and requirements.
• Demonstrate Company's Core Competencies and values held within.
• Please note due to the exposure of PHI sensitive data, this role is considered to be a High Risk Role.
• The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.

JOB SCOPE:

The incumbent works independently and exercises significant independent judgment. The incumbent will manage staff and help provide thorough and appropriate responses to meet the goals of the department. The incumbent provides input to make critical business decisions, including staffing and process improvement, and impacts day-to-day operations through the oversight of coding reviews and providing direction to staff on individual cases. This is a people management job with authority for all HR actions (hiring, separations, discipline, training, etc.).