Clinical Operations Manager - ADA FMLA Req - CCM - Remote

VetJobs

27d•$111,250 - $159,500•Remote

About The Position

Sparrow is establishing a dedicated clinical operations function within its Customer Experience team. This role is responsible for ensuring consistency, defensibility, and clinical rigor in evaluating medical certifications for leave requests and ADA accommodations. The Clinical Operations Manager will build and lead the medical certification review team, standardize team operations, and define the roadmap for the function's growth. This is a foundational role where the manager will define daily operations, create systems and SOPs for consistent and audit-ready outcomes, and collaborate with Compliance, Legal, and CX leadership.

Requirements

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, significant utilization review experience within an insurance company, TPA, or leave-management environment will be considered.
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.
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.

Nice To Haves

Experience building a related team/function preferred.
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.

Responsibilities

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.