Director of Neurology and Behavioral Health - Remote

Primary Responsibilities

• Use clinical, claims and quality data and knowledge of emerging trends in the specialty care industry to identify key opportunities to design large-scale, enterprise-level clinical management programs that drive meaningful affordability, quality, and experience outcomes across diverse populations and lines of business
• Leverage advanced analytics, including artificial intelligence (AI) and large language models (LLMs) when appropriate to enhance program design efficiency, automate insights, and identify innovative clinical pathways that support proactive and personalized care
• Identify high-impact cost drivers, utilization trends, and care variation at scale
• Conceptualize new clinical programs that incorporate technology-enabled care models, digital engagement strategies, and modern decision-support tools for pre and post service medical management and value-based care
• Build feasibility business cases and financial models to assess operational readiness and impact when implemented at scale
• Incorporate evidence-based medical policies, clinical guidelines, and a broad spectrum of actionable insights - including claims data, clinical outcomes data, utilization trends, quality metrics, member-reported outcomes, digital engagement signals, market intelligence, provider performance patterns, and operational throughput data - gathered across markets, providers, and enterprise data sources
• Foster stakeholder alignment and cross-functional collaboration to ensure programs are designed to support national scalability, operational sustainability, and continual innovation

Data-driven strategy

• Analyze claims utilization and variation, clinical, and quality data to identify opportunities for clinical program development and improvement
• Work with program managers and analytics teams to accurately model performance expectations to correlate the expected affordability to the operational reality of the program
• Analyze appeal trends, overturn rates, peer-to-peer outcomes, and clinical documentation to develop targeted interventions, provider feedback loops, and continuous improvement plans
• Collaborate with analytics teams to develop Key Performance Indicators and to build dashboards tracking program performance

Stakeholder Collaboration

• Seek input from network teams, market teams and external vendors to develop program models
• Build and maintain solid relationships with executive leadership across internal teams to ensure effective support and feedback loops and that deliverables are met
• Develop and maintain solid relationships with provider groups/facilities for collaboration on clinical pilots and programs
• Collaborate with Regulatory and Compliance Teams to ensure program compliance with state and federal regulatory requirements

Communication and Presentation Skills

• Speak clearly on complex problems across a wide range of audiences
• Prepare decks and executive summaries for regular updates regarding the clinical program development and performance for Joint Operating Committees, Team Leadership and Executive Sessions

Program Implementation

• Use problem solving skills and make decisions to support program design and feasibility prior to transition to the Clinical Services Implementation team
• Actively participate in clinical, business and operational meetings; ensure business partners, stakeholders and senior management are provided relevant and timely information on the clinical program design and scope for the approval process
• Provide support to the Clinical Services Implementation team and project managers responsible for moving the program initiative through the clinical implementation lifecycle end-to-end
• Actively participate in multidisciplinary teams to achieve program deliverables; Foster and promote collaborative relationships with matrix partners/stakeholders; Establish trust and credibility at all levels of the organization
• Work independently and as a team member

Program oversight and Continuous Improvement

• Monitor clinical program performance and Key Performance Indicators and iterate based on feedback and data
• Solve unique and complex problems with broad impact on the business; translate highly complex concepts in ways that can be understood by a variety of audiences, including senior management

Required Qualifications

• Advanced Degree including Master's degree or PhD in healthcare administration, public health, social services, nursing or a related clinical specialty, or MBA plus clinical background in neurological diseases.
• 5+ years in a leadership or management role in healthcare
• 5+ years of healthcare experience with operational accountability
• Demonstrated ability to design, scale, or operationalize enterprise-level clinical programs or value-based care models across multiple markets or lines of business
• Deep clinical understanding of brain and neurodegenerative conditions
• Familiarity with evidence-based clinical guidelines and policies
• Proven ability to apply clinical insights to program design and outcome measurement
• Experience applying AI-enabled analytics, machine learning tools, or large language model (LLM) capabilities in healthcare program design, clinical operations, or outcome measurement

Preferred Qualification

• Experience applying AI-enabled analytics, machine learning tools, or large language model (LLM) capabilities in healthcare program design, clinical operations, or outcome measurement