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Director, Clinical Operations, Population Health
Emory University. Serves as the primary clinical execution partner for EHP's population health and VBC strategy.
About the role
Key responsibilities & impact- Serves as the primary clinical execution partner for EHP's population health and VBC strategy.
- Drives strategy and execution across core clinical key results: cost trend management, high-cost member intervention, care management, utilization oversight, and HEDIS quality gap closure.
- Leads high-priority clinical initiatives focused on chronic conditions, maternity/pediatric quality, ED/hospital utilization, behavioral health.
- Oversees UM activities in partnership with the TPA, including prior authorization oversight, level of care determination, clinical criteria application, and utilization trend monitoring.
- Leads complex patient case reviews for high-priority and high-cost members, providing clinical judgment, care plan direction, and escalation management.
- Governs disease management programs across cardiac, oncology, behavioral health, MSK, diabetes, CKD, and obesity populations.
- Oversees transitions of care protocols and enforce care management partner SLA accountability.
- Serves as EHP's primary clinical point of contact for all care management, UM, and care gap closure vendor partners.
Requirements
What you’ll need- Active, unrestricted RN licensure in the State of Georgia.
- Minimum 7 years of progressive clinical operations leadership in a health plan, managed care, or equivalent VBC setting.
- Demonstrated track record leading population health programs: disease management, high-risk member intervention, care gap closure, and quality improvement.
- Strong UM experience including prior authorization oversight, level of care determination, and TPA clinical operations oversight.
- Proven ability to independently navigate claims data, population health dashboards, and financial reports without relying on analyst support.
- Experience holding clinical vendors accountable to SLAs, conducting independent data validation, and leading formal performance reviews.
Benefits
Comp & perks- Health and Safety Information Not Applicable
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
clinical operations leadershippopulation health programsdisease managementhigh-risk member interventioncare gap closurequality improvementutilization management (UM)prior authorization oversightlevel of care determinationdata validation
Soft Skills
clinical judgmentcare plan directionescalation managementaccountabilityindependent navigation of data
Certifications
RN licensure