Clinical operations manager - ada fmla req - ccm

ATTENTION MILITARY AFFILIATED JOB SEEKERS - Our organization works with partner companies to source qualified talent for their open roles. The following position is available to Veterans, Transitioning Military, National Guard and Reserve Members, Military Spouses, Wounded Warriors, and their Caregivers. If you have the required skill set, education requirements, and experience, please click the submit button and follow the next steps. This role is remote in the US, but does not hire from PR, AK, HI or CA. This is not open to any OCONUS locations.

MUST HAVE: 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, we will consider significant utilization review experience within an insurance company, TPA, or leave-management environment. 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; experience building a related team/function preferred. 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.

Sparrow is standing up a dedicated clinical operations function within our Customer Experience team to bring consistency, defensibility, and clinical rigor to how we evaluate medical certifications supporting leave requests, ADA accommodations, and to build the operational backbone — team, workflows, systems, and compliance standards — that supports it. This role owns the function as a strategic remit from day one: building and leading the medical certification review (clinical) team, standardizing how the team operates, and setting the roadmap for the function's expansion. This is a builder role. The Clinical Operations Manager will define how clinical operations run day to day, create the systems and SOPs that make outcomes consistent and audit-ready, and represent the function as a peer to Compliance, Legal, and CX leadership.

Here’s What You’ll Do:

• Clinical Operations Leadership 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.
• Process & Systems Development/Improvement 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.
• Compliance & Administration 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.
• Leadership & Planning 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.

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Additional Qualifications/Responsibilities 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, we will consider significant utilization review experience within an insurance company, TPA, or leave-management environment. 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; experience building a related team/function preferred. 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. 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.

Compensation: This is a full-time, exempt position. Compensation ranges from $111,250-$159,500 based on experience and your legal state of residence.