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Director, Clinical Operations
WellSkyDirector of Clinical Operations providing leadership in care coordination and service delivery for healthcare programs. Driving transformational initiatives and enhancing quality in patient care coordination.
About the role
Key responsibilities & impact- Define and execute strategic initiatives to optimize care coordination and scheduling services in alignment with organizational goals and market demands
- Collaborate with senior executives to shape program strategies and address emerging trends in healthcare delivery and payer programs
- Oversee the design and implementation of scalable workflows, operational policies, and resource planning to support efficient, high-quality service delivery
- Lead cross-functional efforts to address systemic challenges, implement process improvements, and ensure compliance with regulatory and contractual requirements
- Utilize data analytics and key performance indicators to monitor program effectiveness, identify improvement opportunities, and guide evidence-based decision-making
- Partner with internal stakeholders to implement quality improvement initiatives that enhance patient and partner outcomes while optimizing resource use
- Represent the team in executive discussions by presenting insights and recommendations to support long-term growth and operational alignment
- Perform other job duties as assigned
Requirements
What you’ll need- Active and unrestricted clinical license – RN
- At least 8+ years of relevant work experience in utilization management/prior authorization/care management, denials, appeals, and clinical nursing in the acute setting
- At least 5+ years of relevant work experience in utilization management or prior authorization experience, including denials and appeals, in or adjacent to a post-acute setting
- At least 8+ years of leadership and/or management experience with staff/HR oversight
- Bachelor's Degree or equivalent work experience
- Extensive knowledge of prior authorization requirements and case management acute workflows
- Experience in Care Port/Care Management utilization review module
- Knowledge of InterQual and/or MCG Guidelines
- Strong interpersonal/communication skills
Benefits
Comp & perks- Excellent medical with Rx, dental, and vision benefits
- Mental Health support through EAP
- Generous paid time off, plus 13 paid holidays
- 100% vested 401(K) retirement plans
- Educational assistance up to $2500 per year
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
Care ManagementPrior AuthorizationClinical NursingData AnalyticsWorkflow DesignOperational Policy ImplementationResource PlanningQuality Improvement InitiativesKey Performance IndicatorsEvidence-Based Decision-Making
Soft Skills
Interpersonal SkillsCommunication Skills
Certifications
Bachelor's DegreeActive Clinical License – RN