Director, Clinical Care Management & Operations

Allegheny Health Network; Pittsburgh (Allegheny County); On-site; USD 120,000 - 160,000; Full time

Job summary

Allegheny Health Network is seeking a leader to drive strategic development of clinical care management and oversee operational excellence across the CM function. This role shapes policies, standardizes workflows, and ensures compliant, high-quality patient care.

You will manage teams through the EPIC core system, track KPIs, and collaborate with utilization management and revenue cycle to align processes and improve outcomes, including reducing readmissions.

Qualifications

• Bachelor’s degree in Nursing, Business, Health Care Management or related field.
• 7 years of management experience in healthcare insurance or healthcare industry with a nursing background.
• Master’s degree preferred.

Responsibilities

• Leads the development and oversees the execution of policies and procedures.
• Directs the standardization of CM policies, practices workflow and data reporting within the system.
• Accustomed to managing through KPIs and provide education/driving towards improvement. Creates consistency/standard work. Manages people daily through EPIC (core system).
• Establishes strategic, tactical and financial plans to optimize the efficacy of clinical operations and utilization management.
• Maintains work plans and annual goals with quarterly results reporting systems that demonstrate performance improvement trends.
• Leads the development of effective communication with internal and external customers to coordinate and adequately address patient care needs.
• Reviews data for trends and analyzes the impact on department operations. Leads the implementation of improved clinical care management models utilization management systems to decrease readmissions, recidivism and excessive length of stay and medical denials.

Skills

Leadership

Strategic planning

Policy development

Data reporting

Collaboration

Education

Bachelor’s degree in Nursing, Business, Health Care Management or related field

Master’s degree

Tools

EPIC (core system)

Job description

Allegheny Health Network is seeking a leader to drive strategic development of clinical care management and oversee operational excellence across the CM function. This role shapes policies, standardizes workflows, and ensures compliant, high-quality patient care.

You will manage teams through the EPIC core system, track KPIs, and collaborate with utilization management and revenue cycle to align processes and improve outcomes, including reducing readmissions.