Sr Dir Clinical Performance & Outcomes

Position Summary

The Senior Director, Clinical Performance & Outcomes is responsible for leading and optimizing Emboss Specialty clinical operations infrastructure, with oversight of Utilization Management operations, clinical services, quality initiatives, accreditation readiness, performance management, process improvement, and operational excellence. This role serves as a strategic leader responsible for ensuring that clinical and operational functions are aligned, scalable, compliant, efficient, and capable of supporting organizational growth and client expectations.

Working closely with the Vice President, Clinical Operations and executive leadership, the Senior Director will establish operational priorities, drive performance outcomes, strengthen organizational capabilities, lead transformation initiatives, and foster a culture of accountability, collaboration, and continuous improvement across clinical and operational teams. The role will serve as a key liaison between clinical leadership, operational departments, compliance, quality, and external stakeholders to ensure exceptional service delivery and execution.

The role provides leadership for Utilization Management clinical and operational teams while also maintaining responsibility for strategic initiatives designed to improve quality, efficiency, regulatory compliance, accreditation readiness, and overall organizational performance.

Essential Responsibilities

Strategic Leadership

• Partner with the Vice President, Clinical Operations to develop and execute operational strategies that support organizational objectives, client commitments, and growth initiatives.
• Translate organizational goals into actionable departmental plans, performance metrics, and operational priorities.
• Lead cross-functional initiatives designed to improve clinical performance, operational effectiveness, and business outcomes.
• Serve as a trusted advisor to senior leadership regarding operational trends, risks, opportunities, and resource requirements.
• Drive organizational change management initiatives and support continuous improvement efforts across clinical operations.

Clinical Operations & Utilization Management Leadership

• Provide oversight and leadership for Utilization Management clinical and operational functions.
• Ensure clinical and operational workflows are efficient, scalable, compliant, and aligned with organizational standards.
• Oversee staffing models, workload distribution, resource allocation, and performance monitoring activities.
• Monitor clinical service delivery, turnaround times, service levels, and productivity metrics.
• Collaborate with clinical leadership to ensure consistency in clinical review processes, utilization management standards, and operational execution.
• Lead efforts to optimize workflows and improve the effectiveness of clinical operations programs.

Performance & Operational Excellence

• Establish and monitor key performance indicators (KPIs), scorecards, dashboards, and operational reporting tools.
• Analyze operational data and performance trends to identify opportunities for improvement and operational efficiencies.
• Develop and implement strategies that improve quality, productivity, service delivery, and employee engagement.
• Ensure departmental goals and individual performance expectations are aligned with organizational objectives.
• Lead root-cause analysis and corrective action initiatives when operational or service issues arise.
• Promote a culture focused on accountability, measurable outcomes, and continuous improvement.

Team Leadership & Talent Development

• Lead, mentor, and develop managers and departmental leaders across clinical and operational functions.
• Foster a culture of collaboration, accountability, innovation, and professional development.
• Oversee hiring, onboarding, succession planning, performance evaluations, coaching, and employee development activities.
• Support leadership development initiatives and strengthen organizational bench strength.
• Ensure training programs are developed, maintained, and effectively delivered to support operational excellence and compliance.

Cross-Functional Collaboration

• Partner with Medical Directors, Clinical Leaders, Operations Leaders, Compliance, Quality, Provider Network, Client Services, Technology, and Finance teams.
• Act as a liaison between clinical and operational departments to ensure alignment and effective execution.
• Support new client implementations, operational launches, process redesign efforts, and strategic business initiatives.
• Collaborate with internal and external stakeholders to address operational issues and improve overall client satisfaction.

Leadership Competencies

• Strategic Thinking
• Operational Excellence
• Healthcare Operations Management
• Change Leadership
• Team Development
• Performance Management
• Regulatory Compliance
• Process Improvement
• Data Analysis and Decision Making
• Relationship Building
• Executive Communication
• Project Management

Required Qualifications

• Bachelor's degree in Healthcare Administration, Nursing, Business Administration, Public Health, or related field, or an equivalent combination of education and experience.
• Minimum of 7 years of progressive healthcare operations, clinical operations, managed care, or utilization management experience.
• Minimum of 5 years of leadership experience managing leaders, managers, and/or multidisciplinary teams.
• Demonstrated experience leading operational performance initiatives, workflow optimization, and organizational change efforts.
• Strong understanding of healthcare operations, managed care principles, utilization management processes, quality programs, and regulatory requirements.
• Experience developing operational metrics, performance dashboards, and executive-level reporting.
• Proven ability to lead high-performing teams in a complex and evolving healthcare environment.
• Excellent communication, problem-solving, relationship management, and leadership skills.

Preferred Qualifications

• Registered Nurse (RN) licensure preferred.
• Master's degree in Healthcare Administration, Business Administration, Nursing, Public Health, or related discipline preferred.
• Experience with NCQA, URAC, Medicare Advantage, Medicaid, and managed care operations.
• Experience leading accreditation readiness, quality improvement, and operational transformation initiatives.
• Experience supporting multi-state healthcare operations and remote teams.

Supervisory Responsibilities

This position directly oversees operational and clinical leadership teams and is responsible for the overall direction, development, performance, and effectiveness of assigned departments. Responsibilities include hiring, coaching, training, performance management, succession planning, employee engagement, corrective action, and team development.