Note: The job is a remote job and is open to candidates in USA. Sedgwick is a global claims management and insurance services company supporting people and organizations facing the unexpected. The VP, Clinical Operations leads the design, delivery, profitability, quality, and client satisfaction of clinical services, with a focus on physical therapy, medical case management, and utilization review. The role oversees national clinical teams, establishes standards and budgets, supports clients, and drives data-informed operational improvements.
Responsibilities
- Plans for staffing needs including successsion, bench-strength, and new business
- Establishes business plan with goals and objectives for the area and locations/offices
- Establishes policy and procedures to assure compliance to best practices, clinical operations service standards, state regulations, and client service requirements
- Establishes and advances physical therapy clinical standards, best practices, treatment guidance, documentation expectations, and quality priorities to support consistent, defensible, and high-value clinical recommendations
- Develops and implements annual budget and manages expenses within established budgetary guidelines
- Assures efficient, cost effective, quality program delivery for medical and disability management
- Responsible for clinical oversight of dedicated units
- Provides client-facing clinical support for physical therapy program reviews, escalations, strategic discussions, and consultative conversations related to outcomes, utilization, treatment quality, and program value
- Collaborates with Claims, Clinical Strategy leaders, Operations, Product, Network, Compliance, Finance, and Analytics partners to align physical therapy services with broader business priorities and integrated service models
- Leverages clinical, operational, and outcomes data to identify trends, guide strategy, support program refinement, and recommend enhancements that improve effectiveness, consistency, and client impact
- Develops training materials to meet training needs
- Manages department's case management and utilization review directors, managers and supervisors, and units nationally. Promotes a culture of continuous improvement, collaboration, accountability, and evidence-based practice across the physical therapy clinical team
- Partners with Clinical Business Operations and other operational leaders to ensure clinical standards are effectively supported within workflows, service expectations, process design, and quality improvement efforts
- Administers company personnel policies in all areas and follows company staffing standards and training recommendations
- Interviews, hires and establishes colleague performance development plans; conducts colleague performance discussions
- Provides support, guidance, leadership and motivation to promote maximum performance
Skills
- Current unrestricted clinical license required
- Certification in case management, rehabilitation nursing or a related specialty OR board certification required
- Ten (10) years of related experience or equivalent combination of education and experience required to include five (5) years of medical case management, three (3) years of clinical quality control, and three (3) years of supervisory experience
- Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
- Computer keyboarding, travel as required
- Hearing, vision and talking
- Bachelor's degree in health-related field or equivalent work experience preferred
Benefits
- Flexible work schedule.
- Referral incentive program.
- Opportunity to work in an agile environment.
- Career development and promotional growth opportunities.
- A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.
- Medical, dental, and vision insurance.
- 401k and matching.
- PTO.
- Disability and life insurance.
- Employee assistance.
- Flexible spending or health savings account.
- Other additional voluntary benefits.
- A variety of professional development opportunities that help you perform your best work and grow your career.
- Flexibility and autonomy in your daily work, your location, and your career path.
Company Overview
Company H1B Sponsorship