Clinical Operations Manager - Virtual Care Management (RN)

Job description

Job Title: Clinical Operations Manager - Virtual Care Management (RN) Location: Remote - United States Employment Type: FT Exempt Direct Reports: Supervisors CareTalk Health CareTalk Health is a virtual-only national medical practice delivering chronic care management and preventive care to Medicare members through health plan partnerships. The Clinical Operations Manager for Virtual Care Management owns the operations that carry a patient forward after the visit — care navigation, longitudinal chronic care management, and remote therapeutic monitoring. About the Role 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.

Responsibilities

• Care 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.

Requirements

• • 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 Requirement This 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. CareTalk Health is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. California applicants: Please review our California Applicant Privacy Notice at Collection before applying. The notice explains the categories of personal information we collect, how we use and retain it, whether we sell or share it, and your privacy rights under California law: https://caretalkhealth.com/california-privacy-notice.

About CareTalk Health

CareTalk Health is a virtual medical practice that partners with healthcare organizations and Medicare Advantage plans to deliver virtual care, including Annual Wellness Visits and care gap closure. They hire registered nurses for remote care management roles where you would prepare Annual Wellness Visit charts, manage medically complex patients across multiple care programs (CCM, RPM, RTM, APCM), conduct virtual patient assessments via Zoom, develop and monitor care plans, coordinate orders, and support preventive and chronic care initiatives—all while working independently across multiple platforms.