Clinical Operations Manager

At Alight, we believe a company’s success starts with its people. At our core, we Champion People, help our colleagues Grow with Purpose and true to our name we encourage colleagues to “Be Alight.”

A – Agile

L – Leadership

I – Integrity

G – Growth Mind Set

H – High Quality

T - Trust

It’s why we’re so driven to connect passion with purpose. Our team’s expertise in human insights and cloud technology gives companies and employees around the world the ability to power confident decisions, for life.

With a comprehensive total rewards package, continuing education and training, and tremendous potential with a growing global organization, Alight is the perfect place to put your passion to work.

Join our team if you Champion People, want to Grow with Purpose through acting with integrity and if you embody the meaning of Be Alight.

Learn more at careers.alight.com.

The Clinical Operations Manager will manage the activities of a team of clinical case managers supporting STD, FMLA and LTD. Also, the Clinical Operations manager will provide oversight and asst in training of all clinical protocols and best practices used by our absence management clinical staff, including Registered Nurses, and Vocational Rehabilitation Counselors. The Clinical Operations Manager will serve as a Senior Clinical reviewer for highly complex, high-profile escalated claims.

You will

Manage a team of clinical case managers (CCM’s)

Lead, motivate, and develop assigned clinical case manager staff

Assess and monitor clinical case manager’s workload capacity and efficiency

Assess and measure staff performance and set appropriate goals

Perform mid-year and annual performance evaluations, communicating expectations, goals, deadlines and team results

Monitor and control personnel issues of clinical claim managers and work directly with Human Resources as needed

Coordinate with other clinical operations managers to provider clinical case management support across Alight’s book of business.

Conduct clinical audits and provide feedback and mentoring, coordinate with clinical leaders on corrective actions as applicable

Support operations claim teams by monitoring and resolving escalated customer complaints related to clinical issues

Participate in the reinforcement of return-to-work best practice protocols and workflows

Occasionally assist with overflow of clinical reviews upon request of manager

Perform side by side listening/shadowing and coaching with team members to assist in further development of clinical staff.

Collaborate with senior clinical reviewer for highly complex high-profile disability claims and/or escalated claims.

Conduct regular clinical round tables to determine level of functional impairment based on knowledge of medical signs and symptoms and the employer’s essential job functions and reinforce methodology of reviewing claims based on best practice case review per medical disability guidelines review protocol.

You have

Bachelor's degree or equivalent experience.

Overall experience of 8+ year

RN license

1-3 years minimum of clinical experience

Minimum of 5 years of experience in disability management and/or managed care

2+ years of supervisory experience

Unrestricted state clinical licensure

Superior clinical case manager skills and eagerness to function in a leadership role

Strong teaching or mentorship skills

Advanced problem-solving and analytical skills

Excellent communication (written/verbal) and relationship building skills

Superior ability to work in a team setting

Ability to communicate complex information in a mentoring/training situation

Strong organization skills, time management and follow-through are essential

Strong presentation skills

Ability to work in evening/night shift

Alight is committed to diversity, equity, and inclusion. We celebrate differences and believe in fostering an environment where everyone feels valued, respected, and supported. We know that diverse teams are stronger, more innovative, and more successful.

At Alight, we welcome and embrace all individuals, regardless of their background, and are dedicated to creating a culture that enables every employee to thrive. Join us in building a brighter, more inclusive future.

Alight is an Equal Employment Opportunity employer and does not discriminate against anyone based on sex, race, color, religion, creed, national origin, ancestry, age, physical or mental disability, medical condition, pregnancy, marital or domestic partner status, citizenship, military or veteran status, sexual orientation, gender, gender identity or expression, genetic information, or any other legally protected characteristics or conduct covered by federal, state or local law. In addition, we take affirmative action to employ and advance in the employment of qualified minorities, women, disabled persons, disabled veterans and other covered veterans.

Alight provides reasonable accommodations to the known limitations of otherwise qualified employees and applicants for employment with disabilities and sincerely held religious beliefs, practices and observances, unless doing so would result in undue hardship. Applicants for employment may request a reasonable accommodation/modification by contacting his/her recruiter.

Applicants for employment in the country in which they are applying (Employing Country) must have work authorization that does not now or in the future require sponsorship of a visa for employment authorization in the Employing Country and with Alight.

Note, this job description does not restrict management's right to assign or reassign duties and responsibilities of this job to other entities; including but not limited to subsidiaries, partners, or purchasers of Alight business units.

We offer you a competitive total rewards package, continuing education & training, and tremendous potential with a growing worldwide organization.

DISCLAIMER:

Nothing in this job description restricts management's right to assign or reassign duties and responsibilities of this job to other entities; including but not limited to subsidiaries, partners, or purchasers of Alight business units.