Senior Director, Clinical Services

Position Summary

The Senior Director, Clinical Services serves as a key leader within the Clinical Services division, functioning as the principal operational and clinical partner to the Senior Vice President, Clinical Services. This role combines strategic leadership, clinical oversight, operational execution, regulatory compliance, and organizational effectiveness to ensure the successful performance of all Clinical Services functions.

Essential Position Functions/Responsibilities

• Serve as the primary operational and clinical partner to the Senior Vice President, Clinical Services, providing leadership, consultation, and execution support across all Clinical Services functions.
• Ensures strategic priorities, initiatives, and organizational goals are effectively coordinated and executed.
• Lead the development, implementation, monitoring, and continuous improvement of departmental goals, objectives, policies, procedures, and operational plans.
• Drive organizational effectiveness through performance management, process improvement, change management, and operational excellence initiatives.
• Coordinate and manage executive-level projects, strategic initiatives, and cross-functional workstreams on behalf of the SVP.
• Prepare executive presentations, dashboards, scorecards, reports, and analyses for senior leadership, health plans, committees, and regulatory agencies.
• Facilitate leadership meetings, action planning sessions, and strategic planning activities for the Clinical Services division.
• Provide oversight and direction for Utilization Management, Care Management, Population Health, Special Needs Plan (SNP) activities, and other clinical operations.
• Maintain responsibility for the UM Program Description, Annual Work Plan, Annual Program Evaluation, and associated regulatory reporting.
• Ensure UM activities are compliant with NCQA accreditation standards, CMS requirements, state regulations, health plan contracts, and organizational policies.
• Review utilization trends, denial patterns, appeals, grievances, and authorization metrics to ensure program effectiveness and compliance.
• Oversee preparation and submission of delegated UM reports and performance metrics to contracted health plans and regulatory entities.
• Ensure timely and accurate UM, QI, and MAC Committee operations, including agenda development, meeting facilitation, documentation, and reporting.
• Support the implementation of evidence-based practices and innovative care management strategies that improve member outcomes and reduce unnecessary utilization.
• Direct the development, implementation, evaluation, and ongoing enhancement of UM policies, procedures, and program infrastructure.
• Monitor clinical performance metrics, utilization trends, quality indicators, and operational outcomes to identify opportunities for improvement.
• Participate in interdisciplinary care team meetings and population health strategy discussions.
• Support implementation and ongoing monitoring of quality and value-based care initiatives.
• Lead special projects, strategic initiatives, and enterprise-wide programs as assigned by the Senior Vice President, Clinical Services.

Qualification Requirements

• Skills, Knowledge, Abilities:
• Extensive knowledge of Utilization Management, Care Management, Population Health, and Quality Improvement principles.
• Expert knowledge of NCQA standards, CMS requirements, managed care regulations, delegated oversight, and accreditation processes.
• Strong strategic planning, organizational leadership, and operational management capabilities.
• Exceptional executive presence, communication, presentation, and relationship-building skills.
• Advanced analytical, critical thinking, and problem-solving abilities.
• Demonstrated ability to influence across all levels of an organization and lead through collaboration.
• Ability to manage multiple priorities in a fast-paced, highly regulated environment.
• Strong financial acumen and understanding of healthcare operations and performance metrics.
• Proficiency with healthcare analytics, reporting tools, and clinical information systems.
• Training/Education:
• Current unrestricted Registered Nurse (RN) license required.
• Bachelor of Science in Nursing (BSN) required.
• Master's degree in Nursing, Healthcare Administration, Public Health, Business Administration, or related healthcare field required.
• Certified Case Manager (CCM) required.
• NCQA Accreditation/Delegation experience required.
• Additional certifications in healthcare management, quality, utilization management, or population health preferred.
• Experience:
• Minimum of 10 years of progressive leadership experience in healthcare operations, clinical services, utilization management, care management, or managed care.
• Minimum of 5 years of senior leadership experience in managed care, health plan, IPA, MSO, ACO, or risk-bearing healthcare organizations.
• Demonstrated experience leading Utilization Management, Care Management, Quality Improvement, and population health programs.
• Experience serving in a highly visible leadership role supporting executive-level decision making and organizational strategy.
• Proven success managing cross-functional teams, regulatory compliance, accreditation activities, and operational transformation initiatives.
• Experience with specialty pharmacy and high-cost medication management preferred.

Base Compensation

$165,000 - $190,000 annually

Bonus Incentive

Eligibility based off organizational performance

Benefits

• Fully paid Medical & Dental employee coverage + robust benefits package (PTO, 401k, FSA, Tuition Reimbursement, etc.)

Equal Employment Opportunity Statement

HealthCare Partners, MSO is committed to fostering a diverse and inclusive workplace. We provide equal employment opportunities (EEO) to all employees and applicants without regard to race, color, religion, sex, national origin, age, disability, genetics, or any other protected status under federal, state, or local laws. In compliance with all applicable laws, HealthCare Partners, MSO upholds a strict non-discrimination policy in every location where we operate. This policy applies to all aspects of employment, including but not limited to recruitment, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

Department

Clinical Services

Job Type

This is a management position

Employment Type

This is a full time position