Who We Are

Because health is personal. That's why Personify Health created the first and only personalized health platform—bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one place. We serve employers, health plans, and health systems with data-driven solutions that reduce costs while actually improving health outcomes. Together, our team is on a mission to empower people to lead healthier lives.

Learn even more about the work that drives us at personifyhealth.com.

Ready To

What You'll Actually Do

ESSENTIAL DUTIES and RESPONSIBILITIES:

The Director of Clinical Operations provides leadership and operational oversight for Utilization Management (UM), Case Management (CM), and Disease/Population Health Management (DM) programs. This role ensures care management operations deliver high‑quality, timely, and cost‑effective services in alignment with clinical standards, regulatory requirements, accreditation expectations, and organizational strategy.

The Director partners closely with Clinical Compliance, Medical Directors, and operational leadership to drive performance, staff readiness, and continuous improvement

Level I – Director, Clinical Care Management Operations (Operational Leadership)

Care Management Operations

• Oversee day‑to‑day clinical operations for UM, CM, and DM teams.
• Ensure operational workflows meet productivity, quality, and turnaround time expectations.
• Monitor staff performance, workload distribution, and case activity metrics.
• Address operational barriers and escalate systemic issues as appropriate.

People Management & Team Development

• Supervise managers and/or clinical leads within Care Management.
• Participate in hiring, onboarding, training, coaching, and performance management.
• Foster team engagement and accountability while supporting consistent application of policies and procedures.

Clinical & Program Oversight

• Ensure care management decisions align with clinical criteria, plan language, and medical policy.
• Support clinical components of cost management strategies and utilization optimization.
• Maintain readiness for clinical operations components of NCQA and URAC reviews.

Collaboration & Communication

• Partner with the VP of Care Management on operational priorities and process improvements.
• Communicate clinical updates, policy changes, and operational expectations to teams.

Level II – Director, Clinical Care Management Operations (Program & Performance Leadership)

Operational Strategy & Performance

• Lead operational strategy across UM, CM, and population health programs.
• Analyze utilization, quality, and outcome data to identify performance trends and opportunities.
• Drive consistency and standardization across teams, states, and client populations.
• Ensure care management operations are scalable and aligned with growth strategies.

Program Development & Optimization

• Oversee implementation and optimization of care management workflows, tools, and technologies.
• Partner with Compliance and Medical Directors to operationalize regulatory and clinical requirements.
• Lead corrective actions resulting from audits, performance reviews, or operational risk assessments.

Leadership & Influence

Serve as a clinical operations subject matter expert for senior leadership.

• Provide input into strategic planning, budgeting, and staffing models.
• Mentor care management leaders and build leadership bench strength.

Senior Director – Clinical Care Management Operations (Enterprise & Strategic Leadership)

Enterprise Operations Leadership

• Set the long‑term vision for Care Management operations across products, clients, and lines of business.
• Ensure operational excellence across UM, CM, and population health programs at scale.
• Balance quality outcomes, member experience, regulatory readiness, and cost stewardship.

Strategic Growth & Innovation

• Lead enterprise initiatives related to care model evolution, automation, and performance optimization.
• Sponsor cross‑functional initiatives that improve care coordination, utilization outcomes, and member impact.
• Ensure Care Management operations support client retention, growth, and differentiation.

Executive Partnership & Governance

• Partner closely with executive leadership, Medical Directors, Compliance, Finance, and Client Services.
• Represent Care Management Operations in enterprise governance, audits, and client discussions.
• Develop future leaders and ensure succession planning for operational leadership roles.

 KEY COMPETENCIES:

To work in the health industries and to work remotely, it has been demonstrated that those with computer skills work better in these remote job descriptions.

What You Bring to Our Team

UPON HIRE, must have:

• Basic computer literacy
• The ability to work on multiple screens, and proficient typing skills.
• Proficiency in software applications including, but not limited to, Microsoft Word, Microsoft Excel, and Outlook
• Ability to speak clearly and convey complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others.
• Ability to work independently and utilize written resources to problem solve. Training and understanding of AI tools like copilot and Claude helpful with the ability to learn and adapt technologies as they become available.
• After training with our training department and 1.5 months ramp (3 months total), must have and be able to work in:
  • Teams on and off camera, SharePoint, Drives as needed, VPN, UM Web or Health Notes, El Dorado, Quick Links, GIAS, ADP, Confluence, Phone system with headset, Smartsheet—there may be additional programs as it relates to particular job duties
• Knowledge of medical claims and ICD-10, CPT, HCPCS coding
• Excellent verbal and written communication skills for upward and downward conversations
• Knowledgeable of the Federal, State and ERISA regulations 

Level I

• Strong operational knowledge of UM, CM, and disease management workflows
• Effective people management and coaching skills
• Ability to manage daily operational priorities and competing demands
• Clear, consistent communication with clinical and non‑clinical teams

Level II

• Advanced performance analysis and operational problem‑solving

• Ability to translate strategy into scalable workflows and metrics
• Strong partnership skills across compliance, medical, and operational teams
• Comfort leading through change and complexity

Senior Director

• Enterprise‑level operational leadership and systems thinking
• Visionary leadership with strong execution discipline
• Ability to align clinical operations with financial, regulatory, and strategic goals
• Executive presence and influence

QUALIFICATIONS:

Level I

• Active, unrestricted Registered Nurse (RN) license
• Associate or Bachelor’s degree in Nursing required
• Minimum 4–6 years of experience in UM, CM, DM, or hospital-based care management
• Prior people management experience strongly preferred

Level II

• Active, unrestricted RN license
• Bachelor’s degree required; Master’s degree preferred
• 6–9+ years of progressive leadership experience in Care Management operations
• Demonstrated success leading multi‑team or multi‑program operations
• Certification in Case Management or Utilization Review preferred

Senior Director

• Active, unrestricted RN license
• Bachelor’s degree required; Master’s degree strongly preferred
• 10+ years of senior leadership experience in managed care operations
• Proven enterprise leadership across UM, CM, and population health programs
• Experience across multiple product lines (self‑funded, fully insured, Medicaid, Medicare) preferred

Physical and Mental Requirements:

• Ability to perform the essential job functions safely and successfully with or without reasonable accommodation, including meeting qualitative and/or quantitative productivity standards.
• Ability to maintain regular, punctual attendance.
• Ability to sit for 6-8 hours.
• Constant use of computer keyboard and mouse; repetitive use of both hands.
• Occasional to frequent twisting of neck; occasional bending of neck and at waist.

This job description is not an exclusive or exhaustive list of all job functions that an employee in this position may be asked to perform. Duties and responsibilities can be changed, expanded, reduced, or delegated by management to meet the business needs of MedCom a Personify Health Company.

Benefits

The Highlights:

• Competitive base salary and benefits effective day one
• Comprehensive medical and dental through our own health solutions (yes, we use what we build)
• Unlimited PTO—rest and recharge time is non-negotiable
• Mental health support, retirement planning, and financial protection
• Professional development with clear career progression and learning budgets
• Mission-driven culture where diverse perspectives drive real impact on people's health

Want the full picture? Visit personifyhealthbenefits.com to explore our complete benefits package, wellness programs, and other employee perks.

Compensation: This position offers a base salary range of $118,560 - $137,280. depending on location, skills, and experience. You're eligible for our full benefits package starting day one.

Our Commitment: Personify Health is an equal opportunity employer committed to diversity, equity, inclusion, and belonging. We cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive—because diversity is core to who we are and critical to our work in health and wellbeing.

Stay Safe: Personify Health will never ask for payment or sensitive personal information like social security numbers during hiring. All official communication comes from verified company email addresses and or our secure applicant tracking system. Suspicious requests? Report them to talent@personifyhealth.com. View all legitimate openings at personifyhealth.com/careers.