Clinical Director

Employment Type: Full-time

Position Overview

The Clinical Director is a key member of the regional clinical leadership team, responsible for executing market-level clinical strategy, supporting provider performance, and coordinating with cross-functional teams to drive quality, utilization, and cost-of-care outcomes. This role focuses on building relationships with providers to collaborate on overcoming operational barriers, reducing administrative burden, and optimizing clinical strategies for the benefit of our members.

Region

• Southeast Region: Georgia, North Carolina, South Carolina, Virginia

Primary Responsibilities

Clinical Strategy Execution & Provider Engagement

• Partner with provider leadership by:
  • Developing and maintaining strong relationships with provider group leaders, ensuring timely communication, education, and collaboration.
  • Strengthening relationships, enhancing clinical performance, and driving improvements in patient experience and operational excellence.
  • Aligning on strategic goals, sharing best practices, and collaborating on initiatives that support quality care delivery and system-wide performance.
• Contribute to the design and operationalization of the region’s clinical strategy by:
  • Driving clinical initiatives across the provider network.
  • Supporting facility and provider population health programs focused on Stars, HEDIS, MRA, chronic condition management, and other efforts to reduce avoidable utilization.
  • Supporting Joint Operating Committees (JOCs) and facilitating implementation with pilots around reducing cost of care and improving chronic health care outcomes.

Data-Driven Performance Management

• Working closely with analytics and finance teams:
  • Monitor key performance indicators, identify trends in quality and utilization, and support the development of targeted action plans.
  • Prepare performance dashboards, conduct root cause analyses, and facilitate provider education and remediation efforts.
  • Collaborate with hospital partners to align on shared performance goals, support data transparency, and drive improvements in clinical outcomes, patient experience, and operational efficiency.
  • Partner with the Regional VP of Health Services to align clinical programs with payer-specific needs and market dynamics.

Innovation & Program Implementation

• Implement regional pilots and vendor-supported programs, ensuring operational readiness and provider adoption:
  • Advancing the rollout of remote monitoring tools, clinical pathway platforms, and other tech-enabled care solutions.
  • Working with hospital teams to integrate innovative solutions into inpatient and transitional care workflows, tracking program performance, escalating barriers to adoption, and contributing to continuous improvement efforts that enhance both provider and patient experience.

Governance & Delegation Oversight

• Participate in governance committees and support vendor and delegation oversight activities:
  • Ensuring compliance with clinical policies, quality standards, and regulatory requirements.
  • Collaborating with hospital leadership to align governance practices.
  • Promoting operational excellence across delegated entities and facility-based care settings.

Qualifications

• Clinical degree with an active unrestricted license (e.g., RN, NP).
• 5+ years of experience in clinical operations, care management, or provider performance improvement.
• 5+ years of experience in the managed care industry, either provider or payer.
• Strong understanding of value-based care, population health, and quality metrics (e.g., Stars, HEDIS, MRA).
• Proficiency in quickly monitoring clinical data.