Director, Clinical Operations

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🇺🇸 United States – Remote

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

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WellSky

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1980

⚕️ Healthcare Insurance

☁️ SaaS

🤖 Artificial Intelligence

💰 Private Equity Round on 2020-07

Healthcare Insurance • SaaS • Artificial Intelligence

WellSky is a leading healthcare technology company dedicated to improving healthcare and community care outcomes worldwide. By offering comprehensive software solutions and analytics, WellSky enables healthcare providers, payers, and community organizations to collaborate and enhance care quality and accessibility. Their focus spans intelligent care management, connected care networks, and transformative analytics, aiming to create more efficient, inclusive, and sustainable healthcare systems. WellSky addresses social determinants of health and emphasizes patient and family engagement, supporting care in various settings including home, long-term, and acute care.

📋 Description

• 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

🎯 Requirements

• 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 • 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

🏖️ Benefits

• 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