As Senior Medical Director of Clinical Operations, you will provide clinical TPA support and guide plan performance optimization as the product owner who links our TPA and navigation functions. You will work in close partnership with our Senior Director of Care Navigation and with other clinical, operational, and corporate leads to set the strategic medical management and affordability agenda for our TPA. You will report to our SVP of Product and Chief Clinical Officer.

Responsibilities

• Maintain understanding of competitive landscape and serve as internal and occasional external-facing thought leader
• Provide subject matter expertise, sign-off, and oversight on plan design, claims processing, utilization management, and payment integrity
• Identify and execute on administrative expense and medical cost savings opportunities through policy and process improvements
• Partner with operational and technology leadership to define and improve upon our role in Utilization Management for both carved-in and carved-out UM models
• Partner with the appropriate Product Development teams to bring innovative and value-creating plan designs to market
• Partner with marketing to support go-to-market and product implementations
• Collaborate with other clinical leaders to develop clinical strategy
• Partner with sales and client success to support their functions and deeply understand our customers and channel partners’ clinical needs
• Inspire others and provide clinical subject matter expertise as needed
• Partner with regulatory and compliance teams to minimize risk
• Participate in audit committee
• Stay abreast of regulatory and accreditation requirements and ensure that we meet them
• Partner with the operational TPA leadership to ensure adherence to best practices

Qualifications

• MD or DO degree, active clinical license recommended
• 15+ years clinical experience with 5+ years in administrative leadership, health plan preferred
• Experience in complex servicing or operations leadership environments
• Clinical domain expertise with a broad knowledge of industry business clinical operations
• Demonstrated success influencing operational process improvement and performance management
• Facile with health plan data and data-driven decision making
• Excellent planning, presentation, and decision-making skills
• Outstanding communications, leadership, and interpersonal skills
• Solid business acumen, analytical, and inquisitive
• Strong emotional intelligence and ability to influence
• Ability to effectively collaborate and execute in a highly matrixed environment
• Self-starter with a “roll up your sleeves” mindset and desire to add value
• Comfortable operating with change and uncertainty
• Team player capable of working effectively with individuals throughout the organization. Proven capabilities in leading in cross-functional, matrixed organizations with multiple stakeholders

Pay Transparency Statement

This is a hybrid position based out of our offices: San Francisco, CA, Plano, TX, or Lehi, UT, with the expectation of being in office at least three weekdays per week. #LI-hybrid

The actual pay rate offered within the range will depend on factors including geographic location, qualifications, experience, and internal equity. In addition to the salary, you will be eligible for stock options and benefits like health insurance, 401k, and paid time off. Learn more about our benefits at https://jobs.collectivehealth.com/#benefits.