Clinical Operations Manager, Utilization Review
JOB SUMMARY
The Operations Manager drives Dane Street ’s Group Health division by aligning daily operational leadership with clinical excellence in a high-volume, fast-paced environment. This role exists to ensure the seamless execution of utilization and independent clinical reviews by providing hands-on direction, capacity management, and clinical guidance to a multidisciplinary team of UR Nurses, QA Specialists, and Customer Service Representatives. By bridging front-line operations with cross-functional leadership, this position directly impacts Dane Street ’s reputation and business growth—consistently delivering on tight turnaround times, rigorous quality compliance, client-specific standards, and overall team productivity.
Mission, Culture & Values
At Dane Street , we believe exceptional employee experiences create exceptional client experiences. Our culture is built on collaboration, continuous improvement, accountability, and care.
We care for our customers, we care for our employees, and we care for one another. Every team member plays an important role in creating an environment where people feel respected, supported, empowered to grow, and inspired to do meaningful work.
What You’ll Do
Operational & Clinical Leadership
- Lead day-to-day operations for the assigned Group Health division, ensuring appropriate workflow, staffing, prioritization, and timely completion of work.
- Oversee Utilization Review Nurses, Clinical Quality Assurance Specialists, Customer Service Representatives, and other assigned operational staff.
- Manage the end-to-end operational workflow, including referral intake, clinical review preparation, quality assurance, client communication, and case completion.
- Serve as a clinical and utilization review subject matter resource for the team, providing guidance on clinical review workflows, utilization management principles, and complex or unusual case scenarios.
- Provide first-line support for clinical and process questions from clinical and non-clinical staff, escalating to Medical Director or senior clinical leadership when appropriate.
- Ensure operational and clinical processes align with client requirements, internal procedures, applicable regulatory requirements, and established utilization management workflows.
- Support new client implementations, volume expansions, and changes in client requirements.
- Lead the team through changing priorities, workflow demands, and business needs while maintaining service and quality expectations.
Performance & KPI Management
- Monitor and manage key performance indicators, including turnaround time, productivity, quality, service levels, and client-specific performance requirements.
- Use operational data and reporting to identify trends, capacity constraints, performance gaps, and opportunities for improvement.
- Establish clear individual and team performance expectations and ensure accountability for established goals.
- Provide ongoing coaching, feedback, and performance management to team members.
- Develop and oversee corrective action or performance improvement plans when appropriate.
- Conduct timely and constructive performance evaluations.
- Recognize and develop high-performing team members and support succession and professional development opportunities.
- Provide leadership with regular updates regarding operational performance, staffing, capacity, risks, and improvement initiatives.
Quality, Training & Process Improvement
- Partner with Quality Assurance, Training, and clinical leadership to maintain consistent, high-quality clinical review processes.
- Monitor quality trends and identify recurring clinical, operational, or knowledge gaps.
- Provide clinical and operational guidance to address identified trends and improve team performance.
- Partner with Training and Quality leadership to develop education, reference materials, and process improvements when recurring opportunities are identified.
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