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Associate Director Clinical Operations- Care Management
View Moreicons, El Paso, Texas, us, 88568
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Associate Director Clinical Operations - Care Management 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:
Associate Director Clinical Operations - Care Management
Job Description:
The Associate Clinical Operations Director is a clinical leadership role dedicated to the Utilization Management and Case Management programs. The Clinical Director is responsible for the clinical and operational program performance in the U.S. to ensure the program is achieving desired goals. Effectively leads the Clinical Operations team to meet or exceed clinical program goals and client contract agreements. Works collaboratively with other geographical leaders to help drive clinical acumen and enhance program delivery. Embraces the whole‑person care model to support individuals as they build confidence to improve coping skills, physical and emotional health, and to participate in a healthy lifestyle.
Education:
Bachelor’s Degree in Nursing (RN); master’s level preferred
Certification in Case Management (CCM) preferred
Experience:
Minimum 7 years as a nurse in a clinical or managed care environment
Experience working with URAC and NCQA accreditation standards and survey processes
Knowledge of state licensure and utilization‑management compliance standards
Minimum 5 years in care/case management and utilization management with emphasis on utilization management
Experience with pre‑authorization, concurrent review, physician review, and appeals processes
Minimum 5 years of management experience, managing remote team members
Minimum 5 years’ experience with government plans (Medicare, Medicaid, Marketplace) preferred
BPO experience a plus
Mandatory Skills:
Understanding of Motivational Interviewing and change theory concepts
Knowledge of state and federal regulations relating to Medicare and Medicaid
Ability to manage multiple projects to successful and timely completion
Demonstrated sound problem‑solving, analytical, and decision‑making skills
Knowledge of quality improvement processes
Excellent communication and presentation skills
Leadership qualities of integrity, the ability to motivate others, and the ability to promote harmony in the workplace
Works effectively leading a team and participating on a team
Strong member advocate: willingness to go above and beyond for best service possible
Ability to assist members in navigating the healthcare system and community‑based resources
Culturally sensitive and competent regarding membership served
Ability to work remotely
Ability to determine when to escalates issues appropriately and in a timely manner
Proficient computer skills
Roles & Responsibilities:
Responsible for clinical and operational program performance
Client‑facing and primary liaison between client and Sagility
Responsible for client management and programmatic delivery
Works with an interdisciplinary care team and internal stakeholders for optimal service delivery and programmatic success
Communicates policy changes, program developments, and updates to stakeholders consistently and timely
Articulates an understanding of all policies and procedures and ensures they are adhered to and tracked if necessary
Manages dedicated teams including UM, CM, accreditation, clinical acumen, training, and quality
Maintains regular and reliable attendance and timeliness
Other duties as assigned
The above statements are intended to indicate the general nature and level of work being performed by employees within this classification. They are not intended to be an exhaustive list of all responsibilities, duties and skills required of employees assigned to this job. Employees in this job may perform other duties as assigned.
Location:
Work@Home, USA, United States of America
Join our team, we are looking forward to talking to you! #J-18808-Ljbffr
Associate Director Clinical Operations - Care Management 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:
Associate Director Clinical Operations - Care Management
Job Description:
The Associate Clinical Operations Director is a clinical leadership role dedicated to the Utilization Management and Case Management programs. The Clinical Director is responsible for the clinical and operational program performance in the U.S. to ensure the program is achieving desired goals. Effectively leads the Clinical Operations team to meet or exceed clinical program goals and client contract agreements. Works collaboratively with other geographical leaders to help drive clinical acumen and enhance program delivery. Embraces the whole‑person care model to support individuals as they build confidence to improve coping skills, physical and emotional health, and to participate in a healthy lifestyle.
Education:
Bachelor’s Degree in Nursing (RN); master’s level preferred
Certification in Case Management (CCM) preferred
Experience:
Minimum 7 years as a nurse in a clinical or managed care environment
Experience working with URAC and NCQA accreditation standards and survey processes
Knowledge of state licensure and utilization‑management compliance standards
Minimum 5 years in care/case management and utilization management with emphasis on utilization management
Experience with pre‑authorization, concurrent review, physician review, and appeals processes
Minimum 5 years of management experience, managing remote team members
Minimum 5 years’ experience with government plans (Medicare, Medicaid, Marketplace) preferred
BPO experience a plus
Mandatory Skills:
Understanding of Motivational Interviewing and change theory concepts
Knowledge of state and federal regulations relating to Medicare and Medicaid
Ability to manage multiple projects to successful and timely completion
Demonstrated sound problem‑solving, analytical, and decision‑making skills
Knowledge of quality improvement processes
Excellent communication and presentation skills
Leadership qualities of integrity, the ability to motivate others, and the ability to promote harmony in the workplace
Works effectively leading a team and participating on a team
Strong member advocate: willingness to go above and beyond for best service possible
Ability to assist members in navigating the healthcare system and community‑based resources
Culturally sensitive and competent regarding membership served
Ability to work remotely
Ability to determine when to escalates issues appropriately and in a timely manner
Proficient computer skills
Roles & Responsibilities:
Responsible for clinical and operational program performance
Client‑facing and primary liaison between client and Sagility
Responsible for client management and programmatic delivery
Works with an interdisciplinary care team and internal stakeholders for optimal service delivery and programmatic success
Communicates policy changes, program developments, and updates to stakeholders consistently and timely
Articulates an understanding of all policies and procedures and ensures they are adhered to and tracked if necessary
Manages dedicated teams including UM, CM, accreditation, clinical acumen, training, and quality
Maintains regular and reliable attendance and timeliness
Other duties as assigned
The above statements are intended to indicate the general nature and level of work being performed by employees within this classification. They are not intended to be an exhaustive list of all responsibilities, duties and skills required of employees assigned to this job. Employees in this job may perform other duties as assigned.
Location:
Work@Home, USA, United States of America
Join our team, we are looking forward to talking to you! #J-18808-Ljbffr