Director, Clinical Operations

This job is responsible for providing visionary leadership and strategic direction for care coordination and service delivery teams supporting healthcare programs. The scope of this role includes driving transformational initiatives to scale operations, enhance quality, and position the organization as a leader in patient care coordination while driving high accountability for operational outcomes.

We invite you to apply today and join us in shaping the future of healthcare!  

Key Responsibilities:

• 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.

Required Qualifications:

• 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.

Preferred Qualifications:

• Bachelor of Science in Nursing preferred, Master’s degree will set you apart.
• 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.

Job Expectations:

• Willing to travel up to 30% based on business needs.
• Willing to work additional or irregular hours as needed.
• Must work in accordance with applicable security policies and procedures to safeguard company and client information.
• Must be able to sit and view a computer screen for extended periods of time.

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WellSky is where independent thinking and collaboration come together to create an authentic culture. We thrive on innovation, inclusiveness, and cohesive perspectives. At WellSky you can make a difference.

WellSky provides equal employment opportunities to all people without regard to race, color, national origin, ancestry, citizenship, age, religion, gender, sex, sexual orientation, gender identity, gender expression, marital status, pregnancy, physical or mental disability, protected medical condition, genetic information, military service, veteran status, or any other status or characteristic protected by law. WellSky is proud to be a drug-free workplace.

Applicants for U.S.-based positions with WellSky must be legally authorized to work in the United States. Verification of employment eligibility will be required at the time of hire. Certain client-facing positions may be required to comply with applicable requirements, such as immunizations and occupational health mandates.

Here are some of the exciting benefits full-time teammates are eligible to receive at WellSky:

• 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