Clinical Operations Director Jobs

Become a part of our caring community The Market Finance Lead is a key member of the Gulf South Region’s finance team responsible for connecting market financial performance with operational effectiveness. This role will partner closely with Corporate Finance, Network Performance, Network Contracting, and regional Health Services teams. This individual will manage a team covering a diverse set of responsibilities around Medicare Advantage financial business operations with a heavy focus on value-based providers. This role reports to the Market Finance Director. This role analyzes financial results, claims experience, utilization trends, contract performance, membership, and provider performance data to identify opportunities, influence business decisions, and support market growth and operational improvement. The Market Finance Lead will partner closely with regional leadership, actuarial, corporate finance, clinical, risk adjustment, market operations, network performance, network contracting, sales/MarketPoint, and value-based care providers. This individual will translate complex financial and operational data into meaningful insights, recommendations, and action plans that improve performance across the market. As the Market Finance Lead, you will: Manage a team to review value-based providers’ financial performance, membership, cost and utilization trends, contractual results, and opportunities for improvement. Lead the financial portion of provider engagement prep sessions prior to joint operating committee meetings to advise the Network Performance team on contract performance and opportunities for improvement. Lead analysis and reporting related to value-based provider and contract performance, including financial results, utilization, claims experience, membership, and operational trends. Leverage data analytics, business ins

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality 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 Summary: Ready to take your Medical Director career to the next level with a Fortune 6 company? Join Aetna, a CVS Health company, and make a meaningful impact on the health and well-being of Medicaid members across the country. Aetna operates Medicaid managed care plans in Arizona, Florida, Illinois, Kentucky, Louisiana, Maryland, Michigan, New Jersey, New York, Ohio, Oklahoma, Pennsylvania, Texas, Virginia, and West Virginia. We are seeking a Medical Director to join our centralized Medical Management team. This work-from-home position will primarily support Aetna Better Health of Louisiana , while also providing support across the other health plans as needed. In this role, you will partner with Medical Management staff to ensure timely, consistent, and clinically sound decisions for members and providers. Key responsibilities include: Utilization Management and medical necessity reviews Prior authorization and precertification determinations Concurrent review for inpatient and outpatient services Acute and post-acute care reviews Peer-to-peer consultations with treating providers Pharmacy reviews and first-level appeal determinations Collaboration with multidisciplinary clinical and operational teams The Medical Director also participates in a rotating on-c

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality 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. Executive Director, Technology Product Management – Medical Cost Initiatives Location: Remote Department: Healthcare Technology & Product Management Reports To: VP, Chief Health Informatics Officer (CHIO) - CVS Healthcare Delivery Role Overview As the Executive Director, Digital Product – Medical Cost Initiatives , you will lead the technology product strategy and execution for key medical cost portfolios for CVS Healthcare Delivery businesses. Core areas of focus are Care Transitions, Patient Segmentation, Chronic Condition Pathways, and Specialty Care Services. In this high-impact executive role, you will partner directly with clinical and business operational leaders to shape end-to-end technology pathways that support CVS Healthcare Delivery care models. You will lead a multidisciplinary team of product managers, Epic analysts, software engineers, data scientists, and UI/UX designers to translate clinical vision into scalable technology roadmaps that optimize patient outcomes and lower the total cost of care. The ideal candidate must have expertise with value-

Become a part of our caring community The Medical Director, National Outpatient Medicare leverages clinical expertise and medical judgment to review preauthorization requests for services. This role is responsible for evaluating moderately complex to complex cases, where analysis of clinical information and situational factors requires in-depth assessment and sound decision-making. As a Medical Director at Humana , you will use your clinical expertise and judgment to make meaningful coverage and care determinations that support quality, consistency, and compliance across the healthcare continuum. In this role, you will review requests for services, level of care, and site of service, using nationally recognized clinical guidelines, CMS policies, medical references, and internal clinical resources to guide decision-making. This position offers the opportunity to work on complex outpatient cases , review clinical documentation, and collaborate with both internal partners and external physicians to gather additional information and discuss determinations. You may also contribute to care management activities and, depending on the role, provide input on areas such as clinical documentation, coding, grievances and appeals, and outpatient services or equipment reviews. Beyond case review, this role provides the opportunity to build strong relationships with physicians, provider groups, facilities, and community partners in support of regional priorities. It is a strong fit for physicians who are interested in contributing to value-based care, population health, and care management strategies while working in a structured environment that values sound clinical judgment, collaboration, and operational excellence. Humana is seeking a Medical Director to

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality 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 Summary Revenue Integrity is seeking a Lead Director, Informatics (Performance Reporting & Insights) to lead the development and delivery of enterprise risk adjustment analytics and business intelligence solutions. This role transforms complex clinical, operational, and risk adjustment data into actionable insights that will drive provider performance, program efficiency, and executive decision-making. This leader will be responsible for creating action through data storytelling, advanced visualizations, and helping to advance the organization’s reporting strategy through AI and automation. This This role is customer-facing and will provide thought leadership and vision partnership to areas such as Market leads, Finance, Clinical, and Operational partners. The leader must also provide technical guidance to staff on BI tool input modeling and calculations. Key Responsibilities Risk Adjustment Performance Reporting Accountable for timely and accurate sharing of risk adjustment KPIs, trends, and performance drivers at a market, plan, and provider level through dashboards and reporting tools Quantify drivers of risk movement and surface those insights to business leaders for action Assess performance against operational and organizational objectives, including appropriate benchmarking and goal setting <

We anticipate the application window for this opening will close on - 25 Sep 2026 Careers that change lives start here. Medtronic is a global leader in healthcare technology with a Mission to alleviate pain, restore health, and extend life. Our 95,000 employees work across more than 150 countries to put patients first — developing innovative medical technologies that improve the lives of 72&#43; million patients each year. Your unique talents will help shape the future of healthcare while building a career grounded in purpose, growth, and impact. A Day in the Life Medtronic’s Neuroscience portfolio focuses on helping people with neurological disorders, spine conditions, and chronic pain live better lives by developing technologies and therapies that reduce pain, restore function, and support daily activities. Our Pelvic Health Operating Unit advances care for patients living with bladder and bowel control conditions through targeted, minimally invasive neuromodulation therapies, including sacral and tibial solutions. Designed to modulate nerve pathways and restore communication between the brain and pelvic floor, these programmable therapies deliver personalized treatment supported by strong clinical evidence and long-term outcomes—helping improve confidence, independence, and quality of life. Click here to learn more about our Pelvic Health Products The Senior Strategic Accounts Director is responsible for leading strategic program development and execution for Pelvic Health Sales, with a focus on driving ASC strategy, strategic contracting, robotics growth, and enterprise account alignment. The role will m

About the team OpenAI’s mission is to build safe artificial general intelligence (AGI) which benefits all of humanity. This long-term undertaking brings the world’s best scientists, engineers, and business professionals into one lab together to accomplish this. In pursuit of this mission, our Go To Market (GTM) team is responsible for helping customers learn how to leverage and deploy our highly capable AI products across their business. The team is made of Sales, Solutions, Support, Marketing, and Partnership professionals that work together to create valuable solutions that will help bring AI to as many users as possible. About the role As an Account Director focused on Healthcare, you will own executive-level relationships with leading healthcare organizations, including integrated delivery networks (IDNs), health systems, academic medical centers, health insurers, digital health companies, and healthcare technology providers. You’ll help these organizations safely and effectively deploy OpenAI’s technology to improve clinical and administrative workflows, enhance patient and provider experiences, automate operational processes, and accelerate enterprise-wide AI adoption. This role blends enterprise sales expertise, technical depth, business acumen, and relationship-driven selling. You will collaborate closely with researchers, engineers, and healthcare-focused solution strategists to design secure, compliant, and high-impact AI deployments. This role is based in San Francisco. We use a hybrid work model of three days in the office per week and offer relocation assistance to new employees. In this role, you’ll: Manage a focused portfolio of large healthcare provider, payer, and healthcare technology accounts, developing long-term strategic account plans. Lead complex, multi-stakeholder sales cycles spanning clinical, operational, IT, digital transformation, and executive leadership teams. Partner with Solutions and Research Engineering to design pilots that demon

Become a part of our caring community The Senior Quality Improvement Professional leads efforts to improve clinical quality and provider performance for the Humana Healthy Horizons in South Carolina Medicaid Plan. You will develop and implement cross-functional quality improvement initiatives, evaluate business processes and performance outcomes, and drive sustainable, measurable improvements. Reporting to the Quality Improvement Director, you will collaborate with internal and external stakeholders to advance a provider-focused culture of quality and performance excellence. You will manage complex projects and analyze diverse data sources to identify opportunities, inform strategy, and support organizational objectives. The Senior Quality Improvement Professional leverages data to lead quality improvement initiatives, monitor performance metrics, and support provider performance enhancement. This role collaborates with provider-facing teams to implement targeted interventions, develop educational resources, and drive achievement of quality and member experience goals. The position leads and participates in multidisciplinary committees, provides strategic clinical guidance on quality initiatives, and influences business decisions through data-driven insights. Operating with a high degree of independence, the Senior Quality Improvement Professional manages complex projects, exercises sound judgment, and recommends solutions to advance organizational objectives. Essential Role Responsibilities The Senior Quality Improvement Professional is responsible for improving clinical quality and performance outcomes among South Carolina network providers. Key responsibilities include: Partner with Provider Engagement, Network, and Contracting teams to implement clinical quality improvement strategies including education, training and performanc

Become a part of our caring community Join a high-impact leadership role at the forefront of healthcare transformation. As the Lead Enterprise Architect, you will shape the future of technology across a complex and rapidly evolving healthcare ecosystem spanning payer, provider, pharmacy, clinical, corporate, and digital technology domains. This is an opportunity to influence enterprise-wide strategy, drive modernization at scale, and partner directly with executive leadership to deliver innovative, secure, and resilient technology platforms that improve business outcomes and healthcare experiences. You'll collaborate with senior tech domain leaders, product and engineering teams, infrastructure organizations, and cybersecurity stakeholders to define modern architecture standards, accelerate innovation, and enable scalable enterprise capabilities across the organization. We're looking for a strategic technology leader who combines deep architecture expertise with strong business acumen and healthcare industry knowledge. The ideal candidate is passionate about solving complex enterprise challenges, influencing organizational direction, and building future-ready platforms that balance agility, performance, security, and operational excellence. You will report to an Associate Director of Enterprise Architecture. The Lead Enterprise Architect is responsible for defining enterprise-wide technology strategy and architecture standards. These standards and modernization roadmaps apply across a complex healthcare ecosystem, which spans payer, provider, pharmacy, clinical, corporate, and tech domains. Additionally, the Lead Enterprise Architect governs digital transformation initiatives. This role partners with executive leadership, product teams, engineering organizations, infrastructure teams, cybersecurity, and business stakeholders to drive enterprise architect

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality 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 Summary The Supervisor, Clinical Health Services is responsible for oversight of healthcare management staff, including the organization and development of high performing teams. In this role, you will: Oversee a non-clinical DE staff Work closely with functional area managers to ensure consistency in clinical interventions supporting our members. Be accountable for meeting the financial, operational and quality objectives of the unit. Oversee the implementation of healthcare management services for assigned functional area. Implement clinical policies & procedures in accordance with applicable regulatory and accreditation standards (e.g. NCQA [ National Committee for Quality Assurance ], URAC [ Utilization Review Accreditation Commission ], state and federal standards, and mandates as applicable). Serve as a content model expert and mentor to the team regarding practice standards, quality of interventions, problem resolution and critical thinking. Ensure implementation and monitoring of best practice approaches and innovations to better address the member's needs across the continuum of care. May act as a liaison with other key business areas. May develop/assist in development and/review new training content. May collaborate/deliver inter and intra-departme

Beacon Biosignals is transforming precision medicine for the brain, from clinical development to clinical care. For Life Sciences partners, we offer the leading at-home EEG platform for clinical development of novel therapeutics for neurological, psychiatric, and sleep disorders. Our Diagnostics business is building the most comprehensive at-home platform for precision diagnostics, combining EEG and cardiopulmonary signals to deliver reimbursable assessments for sleep and central nervous system disorders. Together, we're changing the way patients are diagnosed and treated for any disorder that affects brain physiology. We are seeking a Clinical Trial Operations Associate to join us in our mission to make brain monitoring easily accessible, interpretable, and actionable. In this role, you will collaborate with clinical research sites, project teams, and internal stakeholders to support the deployment of Beacon’s devices in clinical studies. This role focuses on study startup, site management, and live-study monitoring, ensuring the highest quality standards and compliance with regulatory requirements. This role is fully remote anywhere in the Pacific or Mountain Timezones in the U.S. and will require up to 5% travel. Beacon's robust asynchronous work practices ensure a first-class remote work experience, but we also have in-person office hubs available located in Boston, New York, and Paris. What success looks like Collaborate with project teams to support study startup activities. Act as the primary point of contact for clinical sites, ensuring smooth operations and clear communication. Provide training to research sites on the use of Beacon’s devices and study protocols, ensuring proper device usage and data collection. Monitor project progress, ensuring adherence to timelines, protocols, and quality standards. Maintain compliance with Good Clinical Practice (GCP), International Conference on Harmonization (ICH) guidelines, and regulatory standards. A

Nurse Clinical Operations - Registered Nurse — 2 Locations. Apply via Workday.

At Curai, we believe that access to high-quality healthcare is a fundamental human right, not a privilege. Our mission is to radically transform healthcare by harnessing the power of artificial intelligence and clinical expertise to make care more affordable, accessible, and effective for everyone. Curai Health is an AI-powered, virtual multispecialty primary care clinic on a mission to improve access to care at scale. As the pioneer in deploying machine learning into clinical workflows, Curai Health enables its dedicated, specially trained clinicians to deliver primary care to more people at a fraction of the cost. Easy-to-use and convenient, Curai Health partners with insurers and health systems to keep patients engaged in their care over time, improving health outcomes and reducing costs. Our company is remote-first and we consider candidates across the United States. Our corporate office is located in San Francisco. This is a Curai Health, Inc. position.

Job Title: Assistant – Operations Employment Type: Contract (12 months) Location: Bengaluru, India Work Type: Office-based Experience: 1–1.5 years About ClinChoice ClinChoice is a partner to the largest pharmaceutical, medical device, and consumer care innovators in the world. Established in 1995, we provide expertise in clinical operations, biometrics, regulatory affairs, pharmacovigilance, medical affairs, and toxicology to help our partners advance healthcare by accelerating clinical trials with data-driven insights, delivering the best strategies for product registration, and enhancing patient safety through real-world and clinical analysis. Our global delivery network has expanded to centers and satellite offices in the United States, Mexico, the United Kingdom, Armenia, China, Japan, India, and the Philippines to help our customers maintain regulatory compliance locally and globally. We have forged future-defining partnerships with industry bodies and technology companies to develop cutting-edge solutions that deliver our expertise with quality and precision. Primary Responsibilities • Biometric & Access Management: Manage biometric attendance systems and employee access control. Activate access for new joiners and deactivate access for exiting employees. Coordinate maintenance and troubleshooting of biometric devices. Maintain and update biometric and access trackers. • CCTV Monitoring & Maintenance: Monitor CCTV systems and ensure proper functioning. Maintain CCTV time synchronization and recording accuracy. Coordinate with vendors/service providers for maintenance and issue resolution. • Security & Housekeeping Coordination: Supervise security and housekeeping operations. Manage attendance and manpower allocation for security/HK staff. Ensure workplace cleanliness, safety, and operation

Opportunity Overview: This is a hands-on, detail-oriented role embedded within our Clinical Operations and Commercial organizations. The right candidate brings sharp analytical instincts, a bias for action, and the ability to deliver reliable financial support at a pace that keeps up with a fast-moving commercial business. What you’ll do: Review and, where needed, build capacity models for Clinical Operations staff — ensuring headcount aligns with patient volume, operational targets, and cost objectives Update and maintain gross margin workbooks on a monthly basis, incorporating actuals with precision and producing variance commentary that drives decision-making Own headcount management reporting across Clinical Ops and Commercial teams, providing leadership with timely, accurate views of staffing costs vs. plan Analyze the cost impact of process and product improvements, translating operational changes into clear financial outcomes and recommendations Support budget and forecast preparation for both functions — partnering with Operations and Commercial leaders to build credible, data-backed plans Utilize Adaptive Insights (Workday Adaptive Planning) to manage planning cycles, scenario modeling, and financial reporting with efficiency and accuracy Apply AI-powered analytics tools to automate routine tasks, surface insights faster, and continuously elevate the quality of financial outputs This role rewards people who care deeply about the quality and timeliness of their work and who bring a collaborative, ownership-driven mindset to everything they do. Strong attention to detail — gross margin workbooks and capacity models are foundational to how we run the business, and getting them right matters Fast turnaround — leadership relies on timely analysis to make decisions; the expectation is responsive, not reactive Strong partnership instincts — you work closely with Operations and Commercial leaders and must earn their trust through consistent, high-quality support Av