Remote Insurance Utilization Review Jobs in Alabama

About Guideway Care* 

Guideway Care is The Patient Activation Company™. We don\'t just "engage" patients; we activate them. By utilizing our proprietary Motivational Patient Guidance (MPG) model and AI-powered technology, we resolve the practical and psychological barriers that prevent patients from taking their "next right action."™ 

Job Summary: 

The Clinical Operations Manager will oversee the entire Remote RN Triage service line, ensuring high-quality patient care, operational efficiency, and team effectiveness. This role involves managing a team of remote registered nurses who provide triage services to patients, coordinating care, and guiding clinical decisions. The Manager will be responsible for developing and implementing policies and procedures, ensuring compliance with healthcare regulations, and driving continuous improvement in service delivery. 

Essential Functions: 

1. Service Line Management: 

• Lead and manage the Remote RN Triage service line, including staffing, scheduling, and resource allocation. 

• Ensure the service line meets organizational goals for patient care, quality, and operational efficiency. 

• Develop and maintain policies, protocols, and procedures to guide the triage process and ensure consistency in patient care. 

2. Team Leadership: 

• Interview, train, and supervise a team of remote registered nurses, providing regular feedback and performance evaluations. 

• Foster a positive work environment that promotes collaboration, professional development, and high employee engagement. 

• Ensure the team is adequately trained and prepared to handle a variety of patient scenarios, including emergency situations. 

3. Quality Assurance: 

• Monitor and evaluate the quality of care provided by the RN Triage team, ensuring adherence to best practices and regulatory requirements. 

• Implement quality improvement initiatives to enhance patient outcomes and service efficiency. 

• Oversee the development and execution of training programs to maintain high standards of clinical competence. 

4. Customer Coordination: 

• Ensure effective communication and coordination between the triage team, customer success team, and healthcare providers. 

• Develop strategies to streamline care coordination and improve patient satisfaction. 

• Address escalated patient concerns and work to resolve complex clinical issues. 

5. Operational Oversight: 

• Manage the day-to-day operations of the service line, including scheduling, workload distribution, and technology utilization. 

• Analyze performance metrics and operational data to identify trends and areas for improvement. 

• Ensure compliance with all legal, regulatory, and accreditation requirements relevant to telehealth and remote triage services. 

• Any other duties necessary to drive our values, fulfill our mission, and abide by our company values. 

Required Skills/Abilities 

• Education: Bachelor of Science in Nursing (BSN) or Associate Degree in Nursing (ADN) required 

• Licensure: Active and unrestricted Registered Nurse (RN) Compact license. 

• Experience: 

• • Minimum of 5 years of clinical nursing experience 

• • Previous experience in leadership or management role overseeing clinical staff. 
  • Oncology Experience Required

• Skills: 

• • Strong leadership and team management skills. 

• • Excellent communication and interpersonal skills. 

• • Proficiency in using telehealth platforms and electronic health records (EHR) systems. 

• • Ability to analyze data and implement quality improvement initiatives. 

• • In-depth knowledge of healthcare regulations and telehealth best practices. 

Supervisory Responsibilities: 100% 

Travel Requirements: 0 %  

Work Authorization: 

• Guideway Care does not offer Immigration or work visa sponsorship 

Total Rewards: 

The salary range for this position is $80,000 - $100,00 annually. An individual’s salary is based on multiple factors including but not limited to skills, experiences, licensure, certifications, and other business and organizational considerations.  

In addition, team members enjoy … 

Benefits package including: 

• Medical Insurance 

• Vision Insurance 

• Dental Insurance  

• Flexible Spending Account (FSA),  

• Company paid short- and long-term disability,  

• Employee Assistance Program,  

• Life Insurance,  

• Accident insurance,  

• and other voluntary benefit programs for employees and their eligible dependents. 

• 401(k) retirement plan with a company match 

Essential Duties and Responsibilities 

• Able to work remotely at home in a private HIPAA compliant workspace 

• Able to house company equipment needed to perform job 

• Broadband Internet Access 

• Internet download speed must be at least 24 mbps and upload speed at least 4 mbps 

• Immigration or work visa sponsorship will not be provided  

•  Physical Demands: 

• Ability to hear in normal range and wear a headset / earpiece 

• Good visual acuity to read computer screens, scripts, forms etc. 

• May sit 100% of the time when taking calls 

• Access to the electronic medical record (EMR) system may require the use of your personal mobile device for authentication purposes. 

• Guideway Care requires all candidates to successfully complete a background check, drug screening, and identity verification process, including third-party checks and real-time confirmation, prior to employment to ensure a secure and consistent candidate experience. 

We applaud qualified applicants who are accountable and committed to producing quality work. As an Equal Opportunity Employer, we support and value diversity, dignity, and respect in our work environment, and are committed to creating an inclusive environment in which everyone can thrive. 

Guideway Care is the parent company of Sequence Health.