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 better patient, member, business and financial outcomes in partnership with payers and providers. A Leader who can interact closely with members and patients to deliver evidence-based, timely, preventative, personalized, cost-effective care with focus on the whole person that improves 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 requirement
- 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
- Worker?s Compensation
- Population Health Management
- Utilization Management.
- Deep experience working with Aging population
Role Expectation:
- Oversee clinical operations consisting of medical management, population health management to health plan, long term care insurers , ACOs and providers
- Be responsible for business outcomes against budget
- Provide direction and guidance to supervisory team overseeing day to day production and delivery of clinical services
- Provide mentorship for clinicians and support lifecycle management of clinical staff onshore
- Be responsible for performance against SLAs for all clinical programs delivered within the US geography
- Be responsible for execution of policies in compliance to URAC and NCQA standards and generating all relevant artefacts for Audits, participate in audits
- Support timely client implementation of new programs through timely hiring, training and ramp up of staff as per contracts and agreements.
- Be responsible for timely and routine business reviews with internal and client stakeholders.
- Support sales enablement as required
- Participate /collaborate in clinical strategy planning and execution, along with the clinical practice to grow and expand clinical services, capabilities and new offering
- Support new prospect and business development as needed, with timely pricing inputs, contract reviews and inputs for new opportunities
- Stay up to date with market and industry movement in relevant areas for clinical operations such as cost and availability of clinical talent in US, advances in care management, utilization management, new care protocols, pharma, behavioural health, SDoH etc.
- Support client meetings as needed.
Education & Qualifications:
Certified RN or a Postgraduate in Clinical programs such as Pharmacy, or licensed clinical professional
Sagility Offers Competitive Benefits Including:
- Medical
- Dental
- Vision
- Life Insurance
- Short-Term and Long-Term Disability
- Flexible Spending Account
- Life Assistance Program
- 401K with employer contribution
- PTO and Sick Time
- Tuition Reimbursement
Join our team, we look forward to talking with you!
An Equal Opportunity Employer/Vet/Disability
Location:
Work@Home USAUnited States of America
