Clinical Operations Manager

Own end-to-end clinical review of medical certifications submitted in support of leave requests, applying sound clinical judgment to sufficiency and consistency questions.

Oversee day-to-day clinical operations, including intermittent leave analysis and extension evaluations.

Manage the medical certification team, including hiring, coaching, and performance management.

Serve as the clinical escalation point for disputed certifications, working cases through to a defensible resolution.

Support cross-functional execution across Product, Legal, Compliance, and CX.

Resolve operational issues and remove bottlenecks that slow clinical review throughput.

Build and improve operational workflows so outcomes are consistent regardless of reviewer.

Create and update SOPs and documentation-sufficiency standards.

Manage operational systems and reporting, and maintain documentation trails that keep the function audit-ready.

Identify trends across certification reviews and translate them into continuous operational improvements across the clinical review workflow.

Own clinical consistency and compliance oversight for the function.

Manage licensing and credentialing for the clinical team.

Support broader compliance initiatives and coordinate insurance and regulatory requirements.

Partner with Compliance leadership on escalated and legally sensitive cases.

Meet regularly with department leaders to align on operational priorities and performance.

Review operational performance and quality-assurance results; run quality calibration for clinical reviewers.

Set performance standards and design training curricula, including onboarding, for clinical reviewers.

Plan future operational improvements and own the roadmap for expanding the function.

Develop and facilitate ongoing education for Leave Specialist team.

Strong knowledge of FMLA, ADA, and state paid-leave/disability laws as they apply to clinical certification standards.

3+ years experience in disability, leave-of-absence, or claims-related clinical review.

RN license strongly preferred; in lieu of licensure, we will consider significant utilization review experience within an insurance company, TPA, or leave-management environment.

Direct experience managing a care team with expertise in: Short & Long-Term Disability; Family & Medical (Federal and State) Leave Administration; and ADA Accommodations and the Interactive Process; experience building a related team/function preferred.

3+ years of people-management experience.

Experience designing or standardizing operational workflows, SOPs, or training programs.

Strong cross-functional collaborator with comfort partnering with Compliance, Legal, Finance, CX, and Product as a peer.

Comfortable with ambiguity: this role is building a new function, not maintaining an existing one.

Certified Case Manager (CCM) or similar credential a plus.

URAC/NCQA accreditation experience a plus.

Prior experience at a leave/disability carrier or TPA (e.g., Sedgwick, Unum, Lincoln Financial, The Standard, Reliance Standard) a plus.

Our work at Sparrow is impactful. We help People teams with one of the hardest parts of their job, and we support employees at a time when they need it most. We’re driven by our mission, much like a nonprofit, but with the resources and scale of a fast-growing venture-backed company.

Sparrow is proud to be an equal opportunity employer. While we are united by our excitement for the mission and product, the diversity of our experiences is one of our strengths. The Sparrow team is made up of people with all types of backgrounds, and we have teammates in 40 states and counting. To learn more about the Sparrow team and its benefits, check out our careers page.