Director of Clinical Operations

Sagility India Private Ltd in; El Paso (TX); Remote; USD 120,000 - 160,000; Full time

Job summary

Join a dynamic team as a Director of Clinical Operations at a leading organization dedicated to improving health outcomes. In this role, you will oversee clinical operations, ensure compliance with standards, and support the delivery of quality care. Your leadership will drive clinical outcomes and enhance member experience.

Benefits

Medical, Dental, Vision

Life Insurance

Short-Term and Long-Term Disability

401K with employer contribution

Tuition Reimbursement

Qualifications

• Certified RN or postgraduate in Clinical programs such as Pharmacy.
• Licensed clinical professional can also apply.
• Experience in clinical operations management is essential.

Responsibilities

• Oversee clinical operations including medical management and population health management.
• Provide direction to supervisory teams for daily service delivery.
• Ensure compliance with URAC and NCQA standards.

Skills

Finance & Budgeting

P&L management for Clinical Operations

URAC/NCQA regulatory requirements

People management

Contract Negotiations

Clinical Operations

Population Health Management

Education

Certified RN

Postgraduate in Clinical programs

Job description

Director of Clinical Operations (Finance)

About Sagility

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.

Job title: Director of Clinical Operations

Job Description:

Sagility is a global leader specializing in augmenting healthcare teams to improve patient, member, business, and financial outcomes in partnership with payers and providers. We seek a leader who can interact closely with members and patients to deliver evidence-based, timely, preventative, personalized, and cost-effective care focused on the whole person to enhance health, value, and overall quality of life.

We are currently hiring a Director of Clinical Operations to join our team!

Skills Required:

• Finance & Budgeting
• P&L management for Clinical Operations
• URAC/NCQA regulatory requirements
• Report abstraction and report generation for operational performance management
• People management
• Business Process Outsourcing
• Contract Negotiations
• Change Facilitation
• Process Excellence
• Clinical Operations
• Value-Based Reimbursement
• Network & Provider Management
• Health Plan Clinical Operations
• Workers' Compensation
• Population Health Management
• Utilization Management
• Deep experience working with Aging population

Role Expectations:

• Oversee clinical operations including medical management and population health management for health plans, long-term care insurers, ACOs, and providers
• Be responsible for business outcomes against budget
• Provide direction and guidance to supervisory teams overseeing daily clinical service delivery
• Mentor clinicians and support lifecycle management of clinical staff onshore
• Ensure performance against SLAs for all clinical programs within the US
• Ensure compliance with URAC and NCQA standards, including audit readiness
• Support timely client implementation of new programs through hiring, training, and ramp-up of staff as per contracts
• Conduct routine business reviews with internal and client stakeholders
• Support sales enablement as required
• Participate in clinical strategy planning and execution, including expanding clinical services and capabilities
• Assist in new business development with pricing, contract reviews, and opportunity assessments
• Stay informed on market trends in clinical operations, including talent availability, care management advances, and SDoH
• Support client meetings as needed

Education & Qualifications:

Certified RN, or a postgraduate in Clinical programs such as Pharmacy, or licensed clinical professional

Benefits:

• Medical, Dental, Vision
• Life Insurance
• Short-Term and Long-Term Disability
• Flexible Spending Account
• Life Assistance Program
• 401K with employer contribution
• PTO and Sick Leave
• Tuition Reimbursement

Join our team—looking forward to talking with you!

EOE/Vet/Disability

Location: Work@Home USA, United States of America