Clinical Operations Team Lead Full Time

This is a full-time remote role for a Clinical Operations Team Lead focused on Remote Patient Monitoring (RPM) and Chronic Care Management (CCM) programs. The role is responsible for overseeing end-to-end clinical operations, ensuring compliance, optimizing workflows, and driving performance aligned with billing and patient engagement targets.

You will lead the clinical team in delivering high-quality care while ensuring accurate and timely documentation to support billable CPT codes such as 99490, 99439, 99457, 99458, 99453, and 99454. The role requires close collaboration with cross-functional teams including billing, onboarding, and provider groups to ensure seamless program execution and revenue cycle efficiency.

A key responsibility is to monitor nurse productivity and engagement metrics, ensuring that required time thresholds (e.g., 20/40 minutes for CCM, 20-minute interactive communication for RPM) are consistently met. You will proactively identify performance gaps, provide coaching, and implement strategies to improve patient adherence, data collection, and billing outcomes.

Key Responsibilities

• Oversee daily operations of RPM and CCM programs, ensuring compliance with payer and CMS guidelines
• Monitor and drive performance against billing KPIs, including time tracking, patient engagement, and CPT code utilization
• Ensure accurate documentation to support billing for:
• CCM: 99490 (20 mins), 99439 (additional 20 mins)
• RPM: 99453 (setup), 99454 (device supply), 99457 (20 mins interactive), 99458 (additional 20 mins)
• Track and improve patient onboarding, retention, and adherence to meet program targets (e.g., 16+ days of readings for RPM)
• Lead, mentor, and manage the clinical (nurse) team to achieve productivity and quality benchmarks
• Proactively review nurse performance, identify gaps in time logging, patient follow-ups, and documentation, and take corrective actions
• Collaborate with billing and authorization teams to resolve issues related to eligibility, prior authorization, and claim submission
• Analyze operational and clinical data to identify trends and implement process improvements
• Ensure high levels of patient satisfaction and engagement through effective communication and care coordination
• Conduct regular audits to ensure compliance and accuracy in documentation and billing practices 

Qualifications

• Proven experience in RPM/CCM operations and healthcare program management
• Strong understanding of CPT codes (99490, 99439, 99457, 99458, 99453, 99454) and billing workflows
• Experience in managing clinical teams and driving productivity and revenue targets
• Strong analytical skills with the ability to interpret performance data and implement improvements
• Excellent communication and leadership skills
• Familiarity with EMR/EHR systems and care management platforms
• Knowledge of CMS guidelines, payer requirements, and compliance standards
• Bachelor’s degree in Healthcare Administration, Business, or related field (preferred)

Key Success Metrics

• Achievement of billing time thresholds per patient
• Increase in patients meeting RPM/CCM billing criteria
• Improvement in nurse productivity and engagement rates
• Reduction in billing errors and authorization delays
• Growth in active enrolled and compliant patients