Director, Clinical Operations

Job Summary

Leads and directs team(s) responsible for member outreach and scheduling of member visits across all lines of business and states. Participates with senior leadership to establish strategic plans and objectives. Contributes to overarching strategy to provide quality and cost-effective member care.

Essential Job Duties

• Directs member outreach team operations to ensure successful member engagement and scheduling of member visits.
• Implements direction and performance standards to ensure that goals are achieved.
• Manages and evaluates performance of various clinical outreach management activities.
• Aligns with leadership, to ensure operational goals and objectives for outsourced operations are understood and met.
• Ensures services provided to members are compliant with contractual expectations and specific regulatory requirements.
• Demonstrates proficiency in execution of procedures, protocols, benefits, and services.
• Assists with training of new leaders/employees as needed.
• Demonstrates flexibility in meeting changing performance objectives consistent with department objectives.
• Develops standardized methods of improving production, quality and efficiency with vendor and internal partners.
• Utilizes Genesys and Epic platforms to meet business objectives.
• Ensures coverage of all operating hours and the ability to work any business hours, including weekends and some holidays, as needed.
• Ensures internal partners receive operational issue support.
• Produces solutions to problems or issues before making decisions, calculates risks for authority level and takes decisive actions where necessary - ensuring that guidance or action keeps with policy and procedural standards.
• Schedules and reviews project tasks to ensure high quality product is delivered on time and within budget.
• Expands employee performance levels and ensures retention of high performing employees.
• Accurately projects resource needs to ensure timely hiring and training of staff.
• Demonstrates responsibility for vendor development of process improvement requirements, manages communications related to initiatives, and acts as process champion of initiatives.
• Develops executive presentations as needed for review of vendor performance.
• Engages in training activities and outcomes.
• Determines quality measures for success.
• Designs standardized protocols, develops policy, and ensures timely implementation.
• Ensures monthly auditing occurs with appropriate follow-up.
• Facilitates and participates in committees, task forces, work groups, and multidisciplinary teams as needed.
• May be required to travel as needed.

Required Qualifications

• At least 8 years health care experience supporting clinical and contact center operational activities, or equivalent combination of relevant education and experience.
• At least 3 years health care management/leadership experience.
• Experience managing process improvement activities.
• Ability to work cross-collaboratively across a highly matrixed organization.
• Team building and conflict resolution skills.
• Excellent verbal and written communication skills.
• Microsoft Office suite/applicable software program(s) proficiency.

Preferred Qualifications

• Registered Nurse (RN). License must be active and unrestricted in state of practice.

Pay Range: $97,299 - $227,679 / ANNUAL Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.