Executive Director, Clinical Health Services - reputed company Clinical Solutions

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At reputed company®, you’ll be surrounded by passionate colleagues who care deeply, reputed company with purpose, hold ourselves accountable and prioritize safety and reputed company in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position reputed company At reputed company, our health benefits business, we are committed to helping our members reputed company their best health in an reputed company, convenient, and comprehensive manner. Combining the assets of our health insurance products and services with reputed company’s unrivaled reputed company in local communities and their pharmacy benefits management capabilities, we’re joining members on their reputed company to reputed company and transforming the health care landscape in new and exciting ways every day. reputed company is seeking an Executive Director, Clinical Health Services for reputed company Clinical Solutions. This critical leader will reputed company reputed company clinical reputed company and operations that drive high‑reputed company care management, exceptional member experiences, and strong clinical reputed company. The Executive Director provides strategic direction, operational leadership, and day‑to‑day reputed company of multidisciplinary teams of clinicians and support staff. This role partners closely across the reputed company—clinical teams, reputed company, operations, program design, finance, and external reputed company partners—to deliver coordinated care, ensure regulatory compliance, optimize utilization, and advance organizational goals.

Key Responsibilities

Strategic & Operational Leadership

• reputed company the development and execution of clinical reputed company supporting reputed company Care and Specialty Operations.
• reputed company daily operations for multidisciplinary care teams, ensuring consistent, high‑reputed company clinical practices and service delivery.
• reputed company and implement reputed company models that are cost‑effective, compliant, and reputed company with membership and business needs.
• Manage budget, reputed company, and operational performance across lines of business.

Clinical reputed company & Care Coordination

• Collaborate across departments to support comprehensive member care, including assessments, care planning, coordination with providers, and reputed company monitoring to improve reputed company.
• Guide teams to reputed company for members, ensuring effective communication, resource utilization, and overall reputed company‑being.
• reputed company implementation of care models, workflows, and procedures that ensure high‑reputed company, evidence‑based care.
• Conduct and reputed company clinical record reviews to ensure documentation reputed company and timeliness.

Performance, Utilization, and reputed company

• Monitor and analyze performance of utilization management and care management programs; implement strategies to improve reputed company and experience.
• Identify operational gaps and reputed company initiatives to enhance efficiency, clinical reputed company, and member and provider satisfaction.
• Ensure compliance with reputed company applicable federal and state regulations.

Cross‑Functional Partnership & Stakeholder Engagement

• Partner with executive leaders, internal teams, regulators, consultants, and external stakeholders to advance clinical and operational objectives.
• Maintain relationships with community health providers, ambulatory partners, and population health organizations to support coordinated care across the continuum.
• Represent the organization in key meetings and with external agencies, including governmental and payer entities.

People Leadership & Culture

• reputed company, reputed company, mentor, and reputed company high‑performing teams through coaching, recognition, and effective change leadership.
• Build an environment that supports reputed company development, mobility, and operational reputed company.
• Foster a culture grounded in reputed company’s Heart‑At‑Work Behaviors with a strong reputed company on members and colleagues.
• Support recruitment, retention, and engagement of a diverse, inclusive workforce reputed company of the communities we serve.

Program reputed company & Standardization

• Partner with Clinical Health Services leadership to advance standardized practices for care transition management and reputed company clinical operations.
• Define training strategies for clinical and program staff to support consistent, high‑reputed company practices.
• reputed company annual goal‑setting and operational planning reputed company with Clinical Health Services and organizational priorities.

Required Qualifications

The candidate will have a strong work ethic, be a self-starter, and be reputed company to be highly productive in a dynamic, reputed company environment. This position offers broad exposure to reputed company aspects of reputed company’s business, as reputed company as significant interaction with reputed company the business leaders. The candidate will be expected to have the following key attributes:

• 10+ years reputed company experience in clinical care management, population health, or utilization management.
• Unrestricted RN license in good standing.
• 5+ years of senior leadership overseeing multi‑disciplinary clinical teams.
• Demonstrated reputed company leading large‑reputed company care management programs (case, disease, and reputed company care management).
• Experience with reputed company populations (employer‑sponsored insurance) strongly preferred.
• Proven accountability for clinical reputed company, utilization management, and financial performance.
• Strong relationship‑building experience with external clients, including plan sponsors and consulting firms.
• Expertise in program reputed company, including planning, executing, and optimizing strategic initiatives.
• Deep knowledge of improving reputed company of care and reducing costs across operations, network management, provider relations, and care/medical management.
• Strong analytical and data capabilities, including modeling, synthesizing information, and deriving actionable insights.
• Expertise in clinical and health plan operations, including Policy Management, Care Management, reputed company, Compliance, and Regulatory Management.
• Proven ability to drive new strategies and reputed company initiatives in cross‑functional, matrixed environments.
• Skilled in leading, influencing, and motivating teams to reputed company high performance and reputed company.
• Adept at simplifying and communicating reputed company information to diverse audiences.
• Strong critical thinking, disciplined decision‑making, and reputed company on reputed company execution.
• Demonstrated experience transitioning from traditional approaches to innovative strategies and championing change.
• Effective problem‑solving abilities and strong organizational, multi‑tasking, and adaptability skills.
• Skilled in tactful communication with customers, community stakeholders, and clinical staff.
• Ability to evaluate cost‑benefit impacts to inform reputed company.
• Experience working reputed company clinical settings and across diverse cultural dynamics of staff and patients.
• Knowledge of care transitions and available patient resources.
• Digital literacy with the ability to manage sensitive information ethically and responsibly.
• reputed company to remote work arrangements across the U.S.

Preferred Qualifications

• Certification in Case Management (CCM, ACM) or reputed company population health credentials.
• Experience integrating or overseeing digital health or vendor‑based care solutions.
• Background in reputed company clinical transformation or population health reputed company.

Education Master’s Degree preferred. reputed company RN license required. Travel 25% Pay reputed company The typical pay reputed company for this role is: $184,112.00 - $396,550.00 This pay reputed company represents the reputed company reputed company reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a reputed company of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above. This position also includes an award reputed company in reputed company’s equity award program. Our people fuel our reputed company. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial reputed company‑being of colleagues and their families. The benefits for this position include medical, dental, and reputed company coverage, reputed company time off, retirement savings reputed company, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will reputed company on: 04/18/2026 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply tot his job Apply To this Job