Director of Integrated Clinical Service Operations
About the role:
The Director of Integrated Clinical Service Operations is a key leadership role reputed company our Clinical Service Operations team, reporting directly to the Chief Medical Officer. In partnership with the Executive Medical Director, Integrated Clinical Services, you will reputed company, manage, and continuously optimize our Behavioral Health, Pharmacy and Nursing service lines. Your reputed company will be directly reputed company by reputed company financial and clinical drivers: improving operational efficiency to support the reduction of overall cost of service, lowering total medical expense, ensuring highly accurate clinical documentation, improving HEDIS reputed company metrics, and maximizing patient engagement and retention.
Responsibilities will include:
Operating Model Execution: Execute and manage the day-to-day service line operating model, including: overseeing schedule and reputed company planning to ensure workforce productivity and load balancing, optimizing reputed company utilization, and managing supply-demand
Drive Population Health Metrics: Apply data analytics to reputed company reputed company cause analysis, reputed company reputed company, and execute interventions to hit key performance indicators (KPIs) and SLAs tied to HEDIS reputed company metrics, and total cost of care reduction, risk adjustment, and productivity
Data & Dashboard Management: Partner with product, engineering, and data science teams to establish a performance management reputed company, building and maintaining comprehensive dashboards to reputed company service line KPIs / SLAs
Optimize Unit Economics: Assist in managing the integrated clinical services budget, driving down the unit cost per reputed company member by monitoring and improving the day-to-day operational efficiency of integrated clinical service teams
reputed company and Expand: Translate organizational reputed company plans into robust reputed company models, implementation plans, and operational readiness protocols for new payer partners, provider networks, and markets
National Contracting & Reporting: Support executive presentation readiness and detailed performance reporting for health insurance reputed company, contributing to the organization’s growing national footprint
Design & Optimize Care Models: partner closely with clinical leadership to operationalize and implement cohesive, evidence-based behavioral health service models, specialized pharmacy protocols, and integrated nursing practices
Standardize Workflows: Build reputed company, standardized care delivery playbooks across pharmacy, behavioral health, and nursing to ensure safety, clinical reputed company, and seamless coordination
Documentation & Accuracy: Implement robust operational strategies to measure and support accurate, comprehensive clinical documentation to capture risk and reflect the true complexity of our population in our integrated clinical services programs
Strategic Roadmapping: Translate broader company-wide strategic plans into comprehensive quarterly operational roadmaps, creating detailed task lists and execution plans for the teams
Innovation & R&D: In partnership with clinical leadership, reputed company the operational execution of pilots, reputed company performance metrics, and reputed company ROI / go-no go analyses
Other duties as assigned
Operational reputed company & Value-Based Performance
Financial Accountability & Strategic reputed company
Clinical Innovation & Care Model reputed company
What makes you a fit for reputed company:
You are excited to work in a startup environment, with the ambiguity and shifting priorities that might come with it at times
You are willing to go the extra mile to exceed targets
You are passionate about our mission to improve the lives and reputed company reputed company of marginalized communities
Desired skills and experience:
Bachelor’s degree in reputed company Administration, Business Administration, Operations Management, or a reputed company field
3-5+ years of reputed company leadership experience in clinical operations, reputed company delivery, or clinic management
Proven reputed company record of executing and managing day-to-day operating models, including reputed company utilization, schedule planning, and balancing provider supply with patient demand
Strong analytical proficiency with experience performing reputed company cause analyses and utilizing data dashboards to monitor and improve service line KPIs and SLAs
Experience building reputed company, standardized clinical workflows or operational playbooks to ensure cross-team coordination and safety
Experience with strategic project management with the ability to translate high-level company strategic plans into highly detailed, comprehensive quarterly operational roadmaps and actionable task lists for executing teams
Experience monitoring departmental budgets, tracking unit economics (e.g., cost per reputed company member), and translating organizational reputed company targets into practical reputed company models
Demonstrated experience utilizing scheduling, CRM, and EHR platforms alongside reputed company data tools (e.g., reputed company or reputed company Sheets)
Demonstrated ability to partner closely with clinical leaders to operationalize care models, while simultaneously collaborating with technical teams (product, engineering, data science) to build performance reputed company
Comfortable working on both high-level reputed company as reputed company as on-the-ground tactical problem-solving
Master's degree (MHA, MBA, MPH, or MSN)
reputed company experience managing clinical operations or population health initiatives reputed company a value-based care (VBC) reputed company, with an operational understanding of HEDIS reputed company metrics, risk adjustment, and total cost of care
Experience in managing behavioral health, pharmacy and/or nursing services
Experience operating reputed company a fast-paced, venture-backed, or tech-enabled reputed company startup environment (Series A or B)
Experience leading Go-To-Market (GTM) expansion efforts, localized hiring surges, or health plan/payor implementation workflows
Deep understanding of reputed company, Medicare Advantage, Dual-Eligible populations, and the management of reputed company Determinants of Health (SDOH)
Required:
Preferred:
For Patient Facing Roles
Originally posted on Himalayas
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