Job Title: Clinical Operations Manager - Virtual Care Management (RN)Location: Remote - United States
Employment Type: FT Exempt
Direct Reports: Supervisors
You will lead, through a team of supervisors, the work that stays with patients between visits - following up on test results, completing provider orders, keeping care plans current, and checking in on patients managing chronic conditions. Success in this role is measured by follow-through: patients get what they need when they need it, and nothing is left unfinished.
Key ResponsibilitiesCare Navigation Operations- Own daily execution of care navigation - case assignment, prioritization, aging, and closure - ensuring each patient's case is carried cradle to grave by an accountable owner.
- Enforce prioritized workflow standards across time-sensitive work such as returned results, clinical rechecks, order actioning, and returned fax and referral handling.
- Set and manage production expectations, caseload capacity, and turnaround-time standards by task type; monitor queue health daily and reassign before backlogs form.
- Define and maintain role boundaries between RNs, care navigation specialists, clinical leads, and supervisors so escalation paths are unambiguous.
Chronic Care & 24/7 Care Management- Oversee longitudinal care management operations, including care plan production, patient outreach cadence, and documentation completeness against program requirements.
- Manage the daily execution of around-the-clock nursing coverage - shift handoffs, overnight production expectations, and weekend and holiday rotations - ensuring the defined minimum presence is met at all times.
- Ensure inbound patient calls are answered and clinically triaged appropriately across all hours, including rollover coverage from adjacent teams.
- Partner with clinical leadership on scope-of-practice, triage protocols, and escalation to providers.
Remote Therapeutic Monitoring (RTM)- Oversee an RTM team of medical assistants and licensed practical nurses conducting proactive outreach, medication adherence monitoring, and intervention.
- Manage a ratio-driven caseload model - assign and rebalance panels as census grows, and surface to workforce operations when growth outpaces the staffing plan.
- Ensure clinical concerns are escalated promptly to nursing and provider teams, and that billing and documentation requirements for monitoring services are consistently met.
- Maintain patient-service standards on inbound contact even where no formal service level applies.
Intraday Staffing & Coverage- Execute against the published staffing plan across caseload-based, coverage-based, and 24/7 models; make the intraday calls when the day does not go as planned.
- Manage schedule adherence, shift swaps, and same-day absences; approve overtime within plan and escalate anything structural to workforce operations.
- Participate in interviewing, selection, and onboarding for these teams, and flag coverage gaps early so hiring can start on time.
Performance & Compliance- Build and maintain the operating reporting for these teams - throughput, case aging, adherence, census, and quality - and translate it into specific workflow decisions.
- Coach and develop supervisors and clinical leads on performance management, documentation, and accountability.
- Partner with quality and compliance to meet clinical, HIPAA, and health plan contractual requirements, including audit and gap closure reporting.
- Contribute to workflow design, SOP documentation, testing, and training as programs, plan partners, and platform capabilities are added.
Team Leadership, Retention & Engagement- Lead, develop, and hold accountable a team of supervisors; build bench strength and clear role boundaries between leads and supervisors.
- Own retention for the teams under you - set the expectation that attrition is a managed number, not a weather event.
- Track turnover and understand why people leave; act on what you learn through onboarding, workload, scheduling practices, growth paths, and the quality of frontline supervision.
- Drive employee satisfaction and engagement deliberately, on the understanding that how our staff experience their work is what patients feel on the other end of the call.
- Foster a culture where remote team members are visible, connected, and recognized.
Required- Active, unrestricted RN license required, with direct patient care experience; multi-state or compact licensure preferred.
- Experience in a virtual care practice or contact center environment is required - telehealth, care management, disease management, population health, or healthcare contact center operations.
- Demonstrated ability to manage multiple concurrent workflows - several distinct teams, queues, and program requirements running simultaneously, each with different rhythms and deadlines.
- Minimum of 3 years of people leadership experience, including managing supervisors or team leads in a clinical or production operations setting.
- Experience managing caseload or panel-based work and holding a team to throughput and turnaround-time standards.
- Experience managing coverage, adherence, and real-time staffing decisions against a published schedule.
- Demonstrated success retaining staff and reducing attrition, ideally in a remote or high-volume environment.
- Strong data fluency - able to build and interpret operational reporting in Excel and dashboards, and act on what it shows.
- Proficiency with EHR/practice management systems, telehealth platforms, care management documentation tools, and CRM systems.
- Understanding of HIPAA, patient privacy, and healthcare compliance obligations in a remote work environment.
- Availability to support 24/7 operations, including weekend and holiday escalation coverage on a rotating basis.
Preferred Qualifications- Bachelor of Science in Nursing (BSN), or a bachelor's degree in healthcare administration, business, or a related field.
- Direct experience with CCM, APCM, RPM, or RTM program operations, including documentation and billing requirements.
- Experience supporting Medicare Advantage, Medicare Part D, or health plan delegated programs, including quality measure and gap closure work (HEDIS, Star Ratings, SUPD).
- Experience building or restructuring 24/7 coverage models.
- Experience in a high-growth or rapidly scaling healthcare organization.
Core Competencies- Relentless about follow-through; assumes nothing is done until it is documented as done.
- Comfortable holding several unrelated workstreams at once without dropping any of them.
- Clinically credible with nurses and MAs, and operationally credible with executives.
- Self-directed and highly organized in a remote environment.
- Bias toward documenting, standardizing, and simplifying what is currently manual or informal.
Work Location RequirementThis is a remote U.S.-based position. Employees must perform all work physically within the United States. International work is not permitted during scheduled work hours.
Work Environment This is a remote position and may be "on camera" at any time. You will work from a home office, requiring reliable internet connectivity and a secure, private workspace.
Technical Requirements:- Computer:
- Windows or Apple (macOS) Computer ONLY (NO Chromebooks, Linux Machines, or Smartphones)
- Must have at least Windows 10 or macOS 14 Sonoma.
- Hardware:
- Processor: Intel Core i5 or AMD Equivalent (Windows); Apple Silicon (Macs)
- RAM: 16 GB
- Headphones: Wired headphones required for optimal audio quality. (NO built-in mics)
- Internet Speed: Meet minimum internet speed requirements (100 MBPS download speed and 50 MBPS upload speed). Must have an ethernet cable connecting computer directly into router.
- Browser and System: Use Google Chrome with Amazon Workspaces (regardless of computer type).
- Webcam: A webcam is required for video calls. Most laptops have a built-in webcam, which is acceptable. If your computer does not have a webcam, you will need to use an external webcam.
- Recommended Equipment: A second monitor is highly suggested for laptop users; dual monitors for PC users.
