Director, Commercial Clinical Operations- Care Management

Director, Commercial Clinical Operations – Care Management (THM Division)

Are you ready to lead a high-performing clinical team and shape the future of care management? We are seeking a Director of Commercial Clinical Operations to drive innovation, operational excellence, and measurable outcomes across diverse programs—including NICU, maternity, behavioral health, and complex care.

Why This Role Matters

As a key leader, you’ll align clinical strategy with enterprise goals, optimize workflows, and ensure our programs deliver exceptional value to members and groups. You’ll collaborate with Medical Directors, IT, Quality, and Account teams to create a seamless experience that supports health outcomes and client satisfaction.

What You’ll Do

• Lead Strategic Initiatives: Design and execute care management strategies that improve quality, reduce costs, and enhance member engagement.
• Drive Operational Excellence: Oversee workflows, staff utilization, and program performance using data-driven insights and technology platforms.
• Engage Stakeholders: Partner with internal teams and external providers to resolve care coordination challenges and support RFP and finalist presentations.
• Innovate with Technology: Implement solutions that maximize workflow performance while leveraging dashboards, KPIs, and analytics to guide decisions and continuously improve outcomes.
• Build Culture: Foster engagement, transparency, and professional growth within a remote workforce, creating a “destination division” for clinical talent.

What We’re Looking For

• Clinical Expertise: 10 years of clinical experience . In addition, a deep knowledge of care management across diverse populations (NICU, maternity, behavioral health, complex care, etc.) .
• Strategic Leadership:  5 years of leadership experience, aligning clinical programs with enterprise goals, driving innovation, and leading change.  In addition, proven ability to align programs with enterprise priorities and lead change.
• Sales & Client-Facing Experience: Comfortable participating in RFP responses and finalist presentations.
• Technologically Savvy: Must be able to lead and execute a variety of technical implementations as our care management area becomes more focused on leveraging tech. Experience leading and executing at least one technical implementation. A plus for experience utilizing AI to improve processes and productivity
• Operational Acumen: Skilled in managing complex workflows and driving measurable results.
• Analytical Mindset: Comfortable interpreting performance data and using technology to inform decisions.
• Collaborative Communicator: Adept at working cross-functionally and engaging clients.
• Culture Builder: Committed to team development and transparent leadership.

Why Join Us?

You’ll have the opportunity to influence enterprise strategy, innovate care delivery, and lead a team that makes a real difference in members’ lives. If you’re passionate about transforming clinical operations and creating exceptional outcomes, we want to hear from you!

Job Responsibilities

• Strategic Planning: Devise strategies and plans for the clinical department, aligning them with company standards for excellent service and growth.
• Program Development & Design: Ensure programs are aligned with business and market needs, bringing value to organization and group accounts
• Collaboration with Stakeholders: Take active role in partnership with Claims, Customer & Provider Service, Sales and Account management teams; participating in finalist presentations as needed
• Compliance and Quality Assurance: Monitor adherence to legal guidelines, internal policies, and quality standards.
• Budget Oversight: Assume responsibility for budgeting and resource allocation within the clinical area.
• Operations: Oversee all organizational operations, ensuring smooth functioning.

Job Qualifications

Education

• Bachelor's Degree or equivalent work experience required. Equivalent experience is defined as 4 years of professional work experience in a corporate environment.
• Licensure: Re