POSITION PURPOSE

The Clinical Services Director is responsible for providing strategic leadership, clinical oversight, and operational management for Adobe Population Health's Clinical Assessment Services programs, including In-Home Risk Assessments, Risk Adjustment initiatives, and Nurse Practitioner (NP) operations. This leader serves as a key partner to the Medical Director, VP of Clinical Services, and operational leadership teams to ensure the delivery of high-quality, compliant, and patient-centered care that improves outcomes, supports risk adjustment accuracy, and achieves organizational performance goals.

The Clinical Services Director oversees the Nurse Practitioner Manager and clinical assessment teams while ensuring the successful execution of risk assessment programs, quality initiatives, provider engagement efforts, and clinical documentation improvement strategies. This role is responsible for developing scalable clinical processes, monitoring performance metrics, supporting workforce development, and driving continuous improvement across clinical operations.

The ideal candidate is an experienced healthcare leader with strong knowledge of Medicare Advantage, Medicaid, Risk Adjustment (HCC), Quality Programs, and population health management. This individual thrives in a fast-paced environment, is highly collaborative, and possesses the ability to balance strategic planning with hands-on operational leadership.

This position reports directly to the Vice President of Clinical Services and works closely with the Medical Director and executive leadership team.

This position follows a hybrid work schedule, with three (3) days per week in the Phoenix office and travel up to 25% based on business needs.

DUTIES & RESPONSIBILITIES

Clinical Leadership & Program Oversight

• Provide strategic and operational leadership for all Clinical Assessment Services programs, including:
  • In-Home Risk Assessments
  • Telehealth Risk Assessments
  • Risk Adjustment initiatives
  • Clinical documentation improvement efforts
  • Nurse Practitioner operations
• Establish clinical standards, workflows, and best practices to ensure consistent delivery of high-quality care.
• Ensure all clinical services align with organizational objectives, regulatory requirements, contractual obligations, and industry best practices.
• Serve as a clinical resource and subject matter expert for Nurse Practitioners, clinical leaders, and operational teams.
• Collaborate with Medical Directors, Quality, Compliance, Operations, and Provider Engagement teams to drive organizational success.
• Identify opportunities to improve patient outcomes, operational efficiencies, member satisfaction, and clinical performance.

Nurse Practitioner Leadership & Workforce Development

• Provide direct oversight and support to the Nurse Practitioner Manager and NP teams.
• Lead recruitment, onboarding, training, mentoring, retention, and succession planning efforts for clinical staff.
• Conduct performance evaluations, competency assessments, coaching sessions, and corrective action plans as needed.
• Develop and implement ongoing education programs focused on:
  • Risk Adjustment
  • HCC Documentation
  • Clinical Documentation Improvement (CDI)
  • CMS Regulations
  • Medicare Advantage requirements
  • Population Health best practices
• Foster a culture of accountability, engagement, collaboration, and continuous learning.
• Ensure staffing models appropriately support business needs and growth objectives.

Risk Adjustment & Clinical Documentation Improvement

• Lead Risk Adjustment strategies to improve coding accuracy, documentation integrity, and HCC capture.
• Develop and execute Risk Adjustment improvement initiatives and remediation plans.
• Identify documentation gaps through chart reviews, audits, and data analysis.
• Partner with providers and clinical teams to improve:
  • Suspect closure rates
  • Coding accuracy
  • Documentation quality
  • Chronic condition management
• Develop tools, dashboards, and reporting mechanisms to monitor Risk Adjustment performance.
• Educate clinical teams on CMS Risk Adjustment methodologies and documentation requirements.
• Ensure Risk Adjustment initiatives align with contractual performance metrics and organizational goals.

Quality, Compliance & Regulatory Oversight

• Participate fully in the Quality Assurance Performance Improvement (QAPI) program and other quality initiatives.
• Ensure compliance with:
  • CMS regulations
  • Medicare Advantage requirements
  • Medicaid requirements
  • State and federal healthcare regulations
  • HIPAA requirements
  • Accreditation standards
• Lead clinical audits, workflow reviews, and quality assessments.
• Develop corrective action plans and monitor improvement efforts.
• Identify and mitigate clinical, operational, and compliance risks.
• Collaborate with Quality and Compliance teams to prepare for audits, accreditation reviews, and regulatory assessments.

Operational Leadership & Performance Management

• Establish strategic goals and operational objectives aligned with organizational priorities.
• Develop and monitor key performance indicators (KPIs) related to:
  • Productivity
  • Clinical quality
  • Patient outcomes
  • Risk Adjustment performance
  • Member satisfaction
  • Provider satisfaction
• Analyze performance data and implement process improvement initiatives.
• Develop and maintain policies, procedures, workflows, and operational standards.
• Monitor departmental budgets, staffing resources, and operational performance.
• Communicate departmental performance, challenges, and opportunities to executive leadership.
• Support organizational growth initiatives and expansion into new markets.

Patient Care & Clinical Support

• Conduct in-home assessments and clinical visits as needed to support operations, training, quality initiatives, and business continuity.
• Ensure timely identification and intervention for urgent and emergent patient situations.
• Promote patient-centered care and positive health outcomes.
• Collaborate with providers, caregivers, community resources, and interdisciplinary teams to improve care coordination.
• Support care gap closure initiatives and preventative health programs.

Collaboration & Stakeholder Engagement

• Develop strong relationships with:
  • Medical Directors
  • Providers
  • Health Plans
  • Clinical Staff
  • Operations Leaders
  • Community Partners
• Serve as a liaison between clinical operations and organizational leadership.
• Participate in organizational committees, workgroups, and strategic initiatives.
• Promote a culture of collaboration and shared accountability.

Professional Development

• Maintain professional competence through continuing education, certifications, conferences, and industry engagement.
• Stay informed of emerging healthcare trends, CMS regulations, Risk Adjustment updates, and population health best practices.
• Contribute to innovation and continuous improvement across the organization.
• Perform other duties as assigned.

SKILLS & QUALIFICATIONS

• Seven (7) years of progressive clinical and healthcare setting experience.
• Five (5) years of experience in population health, home health, value-based care, managed care, risk adjustment, or a related space.
• Three (3) years of management experience overseeing clinical teams and operations.
• In-depth knowledge of CMS guidelines and the HCC Risk-Adjustment Model.
• Experience working with and understanding of STARS/HEDIS measures.
• Experience in implementing new structures, processes, and roles in support of rapidly shifting business demands.
• Experience leading and managing teams, with strong leadership, coaching, and mentoring skills.
• Demonstrated experience overseeing teams across multiple states, service lines, or regulatory environments.
• Demonstrated ability to lead organizational change and foster a culture of accountability and continuous improvement.
• Excellent analytical and problem-solving abilities, with a keen eye for detail.
• Strong interpersonal and communication skills, capable of interacting with individuals at all levels of the organization.
• Proven track record of implementing successful quality improvement initiatives and driving organizational change.

EDUCATION, LICENSES, & CERTIFICATIONS

• Master's Degree in Nursing (MSN), Advanced Practice Nursing, or related healthcare field.
• Current and unrestricted Nurse Practitioner license in Arizona.
• Current DEA registration (if applicable).
• Willingness to obtain and maintain additional state licenses as required by business needs.

BENEFITS & TOTAL REWARDS

• Paid Orientation and Training
• Insurance - Medical, Dental, Vision, and Life
• 401k Plan - 3% match
• Employee Assistance Program
• Tuition Reimbursement
• Continued Education Support
• Mileage Reimbursement (if applicable)
• Referral Bonuses
• Paid Holidays (9 days)
• Flexible Time Off
• Paid Volunteer Hours

CHARACTER & COMPETENCIES

• Courage - To have the courage to the right thing at the right time.
• Ownership - To take ownership of every issue you touch.
• Respect - To respect yourself, co-workers, and for those whom you care.
• Excellence - To be excellent in all that you do.
• Diversity - Demonstrates knowledge of EEO policy; Shows respect and sensitivity for cultural differences; Educates others on the value of diversity; Promotes a harassment-free environment; Builds a diverse workforce.
• Ethics - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethics; Upholds organizational values.
• Adaptability - Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events.
• Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
• Interpersonal Skills - Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things.
• Judgement - Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions.
• Problem-Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem-solving situations; Uses reason even when dealing with emotional topics.
• Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.
• Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed.

PHYSICAL DEMANDS & WORK ENVIRONMENT

• Occasionally required to stand.
• Occasionally required to walk.
• Continually required to sit.
• Occasionally required to climb, balance, bend, stoop, kneel, or crawl.
• Continually required to talk or hear.
• While performing the duties of this job, the noise level in the work environment is usually moderate.
• May occasionally lift and /or move more than 30 pounds.
• Must be able to physically perform the essential duties of the position which include lifting 30 lbs., transporting materials, stooping, kneeling, crouching, reaching, use of hands, balancing, walking, standing, talking, hearing, and typing.