Director, Clinical Operations
WellSky · United States · 4 days ago
RemoteRemoteAnalystFull-time
Key Responsibilities
- Define and execute strategic initiatives to optimize care coordination and scheduling services in alignment with organizational goals and market demands.
- Collaborate with senior executives to shape program strategies and address emerging trends in healthcare delivery and payer programs.
- Oversee the design and implementation of scalable workflows, operational policies, and resource planning to support efficient, high-quality service delivery.
- Lead cross-functional efforts to address systemic challenges, implement process improvements, and ensure compliance with regulatory and contractual requirements.
- Utilize data analytics and key performance indicators to monitor program effectiveness, identify improvement opportunities, and guide evidence-based decision-making.
- Partner with internal stakeholders to implement quality improvement initiatives that enhance patient and partner outcomes while optimizing resource use.
- Represent the team in executive discussions by presenting insights and recommendations to support long-term growth and operational alignment.
Required Qualifications
- Active and unrestricted clinical license – RN.
- At least 8+ years of relevant work experience in utilization management/prior authorization/care management, denials, appeals, and clinical nursing in the acute setting.
- At least 5+ years of relevant work experience in utilization management or prior authorization experience, including denials and appeals, in or adjacent to a post-acute setting.
- At least 8+ years of leadership and/or management experience with staff/HR oversight.
- Bachelor's Degree or equivalent work experience.
Preferred Qualifications
- Bachelor of Science in Nursing preferred, Master’s degree will set you apart.
- Extensive knowledge of prior authorization requirements and case management acute workflows.
- Experience in Care Port/Care Management utilization review module.
- Knowledge of InterQual and/or MCG Guidelines.
- Strong interpersonal/communication skills.