Our client is seeking an experienced Healthcare Operations professional to join their team, located in the Northeast Region of the US, to work in the capacity of Director of Clinical Operations. The chosen candidate will provide business leadership and administrative oversight, program development, implementation and evaluation of the Utilization Management, Case Management, Outreach and Disease Management Programs impacting health for individuals and populations. The Ideal candidate will possess a depth and breadth of experience focusing on ensuring enterprise-wide compliance with clinical and service requirements and multi-state regulations.
*Perform management responsibilities including, but not limited to: involved in hiring and termination decisions, coaching and development.
Plan, organize, staff, direct and control the day-to-day operations of the department
*Develop and implement policies and programs as necessary; may have budgetary responsibility and authority.
* Maintain fiscal responsibility for departmental operations; oversight for the development, implementation and evaluation of the department budget
* Oversight of UM, CM and DM operations to ensure medically necessary services are provided in a timely, cost effective and quality manner and at the appropriate level of care.
* Establish operational as well as outcome monitoring systems related to clinical improvement initiatives which includes the analysis and review of health cost data and internal/external benchmarks to identify opportunities for clinical quality improvement, cost savings and support of revenue maximization.
* Provide effective leadership, strategic direction and business planning for Clinical Services department including UM, CM, DM and outreach activities to measure and improve quality of health care provided to members.
Best Industry - Healthcare, Medicare or Medicaid
Best Department ? Clinical Services
Bachelor's Degree in Health Administration, Public Health or a related discipline is required.
5 - 7 years of management experience leading and managing a team of direct reports is required.
3 - 5 years of experience within the insurance industry, managed care support, or utilization review is required.
Experience with Managed Care is required.
Experience with Lean/Six Sigma methodology is preferred.
Excellent communication skills (i.e. verbal, written, organizational and presentation) are required.
Proficiency utilizing MS Office (i.e. MS Word, MS Excel, MS PowerPoint, MS Outlook and MS Project) is required.
Ability to function effectively in a fast paced environment and multi-tasking is required.
Up to 15% Domestic/Regional travelrequired.
US Citizens or Green Card holders only apply. No H1b visa sponsorship will be offered with this position.