Remote Senior Manager, Clinical Governance & Performance

CommunityCare HMO Inc.; Tulsa (OK); On-site; USD 110,000 - 170,000; Full time

Job summary

CommunityCare HMO Inc. seeks a Director to lead governance, audit readiness, training, policy management, and corrective action oversight across Physical Health, Behavioral Health, Pharmacy UM, and Appeals and Grievances.

Reporting to the CMO, this role guides regulatory alignment, accreditation readiness, and performance improvement while coordinating staff development and cross‑functional initiatives with clinical and operational leaders.

Qualifications

• Leadership of governance and audit readiness programs.
• Experience with CMS, URAC, marketplace audits.
• Translate regulatory requirements into practical processes.
• Experience leading multidisciplinary teams or functions.
• Strong written, verbal, facilitation and presentation skills.
• Background in health care operations and compliance.

Responsibilities

• Lead governance and performance activities across Physical Health UM, Behavioral Health UM, Pharmacy UM, and Appeals and Grievances.
• Maintain readiness for CMS, Marketplace, state, URAC, delegated oversight, contractual, and internal audits.
• Develop and oversee risk-based internal and delegated entity audits, including reviews.
• Establish standardized audit tools, sampling methods, scoring, and reporting.
• Analyze audit results to identify trends, gaps, and improvement opportunities.
• Oversee corrective action plans with owners, timelines and monitoring.
• Escalate material findings and delegate performance concerns to CMO and leaders.
• Oversee training and policy management; ensure desk procedures and documents are current.
• Monitor regulatory changes and coordinate updates across policies and practices.
• Partner with Compliance, Legal, Quality, Contracting, Credentialing, HR and others.

Skills

Leadership

Regulatory knowledge

Analytics

Cross-functional

Communication

Project management

Integrity & discretion

English fluency

Education

Bachelor’s degree in health care administration

Advanced degree or certification (preferred)

Job description

CommunityCare HMO Inc. seeks a Director to lead governance, audit readiness, training, policy management, and corrective action oversight across Physical Health, Behavioral Health, Pharmacy UM, and Appeals and Grievances.

Reporting to the CMO, this role guides regulatory alignment, accreditation readiness, and performance improvement while coordinating staff development and cross‑functional initiatives with clinical and operational leaders.