Director of Clinical Operations

Overview

Who We Are

Because health is personal. That's why Personify Health created the first and only personalized health platform—bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one place. We serve employers, health plans, and health systems with data-driven solutions that reduce costs while actually improving health outcomes. Together, our team is on a mission to empower people to lead healthier lives.

Learn even more about the work that drives us at personifyhealth.com.

Responsibilities

Ready To

 

What You'll Actually Do

 

ESSENTIAL DUTIES and RESPONSIBILITIES:

The Director of Clinical Operations provides leadership and operational oversight for Utilization Management (UM), Case Management (CM), and Disease/Population Health Management (DM) programs. This role ensures care management operations deliver high‑quality, timely, and cost‑effective services in alignment with clinical standards, regulatory requirements, accreditation expectations, and organizational strategy.

The Director partners closely with Clinical Compliance, Medical Directors, and operational leadership to drive performance, staff readiness, and continuous improvement

 

Level I – Director, Clinical Care Management Operations (Operational Leadership)

Care Management Operations

• Oversee day‑to‑day clinical operations for UM, CM, and DM teams.
• Ensure operational workflows meet productivity, quality, and turnaround time expectations.
• Monitor staff performance, workload distribution, and case activity metrics.
• Address operational barriers and escalate systemic issues as appropriate.

People Management & Team Development

• Supervise managers and/or clinical leads within Care Management.
• Participate in hiring, onboarding, training, coaching, and performance management.
• Foster team engagement and accountability while supporting consistent application of policies and procedures.

Clinical & Program Oversight

• Ensure care management decisions align with clinical criteria, plan language, and medical policy.
• Support clinical components of cost management strategies and utilization optimization.
• Maintain readiness for clinical operations components of NCQA and URAC reviews.

Collaboration & Communication

• Partner with the VP of Care Management on operational priorities and process improvements.
• Communicate clinical updates, policy changes, and operational expectations to teams.

 

Level II – Director, Clinical Care Management Operations (Program & Performance Leadership)

Operational Strategy & Performance

• Lead operational strategy across UM, CM, and population health programs.
• Analyze utilization, quality, and outcome data to identify performance trends and opportunities.
• Drive consistency and standardization across teams, states, and client populations.
• Ensure care management operations are scalable and aligned with growth strategies.

Program Development & Optimization

• Oversee implementation and optimization of care management workflows, tools, and technologies.
• Partner with Compliance and Medical Directors to operationalize regulatory and clinical requirements.
• Lead corrective actions resulting from audits, performance reviews, or operational risk assessments.

Leadership & Influence

Serve as a clinical operations subject matter expert for senior leadership.

• Provide input into strategic planning, budgeting, and staffing models.
• Mentor care management leaders and build leadership bench strength.

 

Senior Director – Clinical Care Management Operations (Enterprise & Strategic Leadership)

Enterprise Operations Leadership

• Set the long‑term vision for Care Management operations across products, clients, and lines of business.
• Ensure operational excellence across UM, CM, and population health programs at scale.
• Balance quality outcomes, member experience, regulatory readiness, and cost stewardship.

Strategic Growth & Innovation

• Lead enterprise initiatives related to care model evolution, automation, and performance optimization.
• Sponsor cross‑functional initiatives that improve care coordination, utilization outcomes, a