Clinical Operations Director in United States

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

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. Company: Oak Street Health Title: Manager, Care Program Strategy & Operations (Vaccine) Location: Remote/Virtual Role Description: The Manager, Care Program Strategy & Operations (Vaccine) plays a critical role within Oak Street Health’s Population Health organization, supporting the design, implementation, and scaling of programs that improve patient health outcomes and advance value-based care objectives. This role focuses on vaccine strategy and execution, driving initiatives that improve immunization rates, close care gaps, and support preventative care delivery across the organization. Serving as a key cross-functional leader, this individual partners closely with Population Health, Clinical Operations, Nursing, Providers, Patient Safety, Epic, and external healthcare partners to develop and implement innovative solutions that improve patient outcomes and operational performance. The role requires strong project management capabilities, stakeholder influence, and the ability to execute complex initiatives across multiple teams and partners. This is a highly visible role responsible for bringing new ideas from concept to execution, including the development of pilot programs, evaluation of results, and scaling of successful interventions across Oak Street Health centers nationwide. The Manager will also support strategic partnerships an

At Gilead, we’re creating a healthier world for all people. For more than 35 years, we’ve tackled diseases such as HIV, viral hepatitis, COVID-19 and cancer – working relentlessly to develop therapies that help improve lives and to ensure access to these therapies across the globe. We continue to fight against the world’s biggest health challenges, and our mission requires collaboration, determination and a relentless drive to make a difference. Every member of Gilead’s team plays a critical role in the discovery and development of life-changing scientific innovations. Our employees are our greatest asset as we work to achieve our bold ambitions, and we’re looking for the next wave of passionate and ambitious people ready to make a direct impact. We believe every employee deserves a great leader. People Leaders are the cornerstone to the employee experience at Gilead and Kite. As a people leader now or in the future, you are the key driver in evolving our culture and creating an environment where every employee feels included, developed and empowered to fulfil their aspirations. Join Gilead and help create possible, together. Job Description The Clinical Program Manager is responsible for the worldwide execution of all Phase I - IV clinical trials across all Gilead therapeutic areas. Clinical Operations plays a key role in ensuring all Gilead clinical trials are performed in accordance with applicable SOPs, company policies and regulatory guidelines to provide timely and high-quality clinical data that supports global registration and commercialization of Gilead’s products. You will oversee and be responsible for the successful execution of studies and/or multiple studies within a program or multiple programs, including financial responsibility. You will be responsible for the resource management of studies, includi

This is where your work makes a difference. At Baxter, we believe every person—regardless of who they are or where they are from—deserves a chance to live a healthy life. It was our founding belief in 1931 and continues to be our guiding principle. We are redefining healthcare delivery to make a greater impact today, tomorrow, and beyond. Our Baxter colleagues are united by our Mission to Save and Sustain Lives. Together, our community is driven by a culture of courage, trust, and collaboration. Every individual is empowered to take ownership and make a meaningful impact. We strive for efficient and effective operations, and we hold each other accountable for delivering exceptional results. Here, you will find more than just a job—you will find purpose and pride. At Baxter, our mission is to save and sustain lives. As a Sr. Clinical Solutions Specialist, you will partner with healthcare organizations to implement and optimize Baxter's Care Communications solutions, including nurse call and digital health technologies. In this role, you will apply your clinical knowledge to assess workflows, support system implementation, and guide organizations through the adoption of technology solutions that enhance communication and care delivery. Success is measured by the effective deployment of clinical solutions, customer adoption, and achievement of implementation milestones. Your Team You will be part of the Care Communications Clinical Operations team, supporting healthcare customers throughout the implementation lifecycle. The team works closely with Project Managers, Implementation Specialists, Engineers, Account Managers, and Care Communications leaders to deliver clinical technology solutions

SUMMARY STATEMENT We are looking for a Solution Architect to design the technical solutions behind our client engagements and give delivery teams a clear, workable path from concept to production. You will work across enterprise data, software applications and GenAI - translating complex business problems into practical architectures that delivery teams can build and scale. This could include architecting an agentic workflow for clinical operations, a conversational analytics product grounded in enterprise data, or an AI-enabled decision platform for commercial teams. You will work directly with clients, define the architecture, test the most important technical decisions yourself and establish the foundations for successful delivery. This is an architecture-first role with meaningful hands-on engineering: you will stay close enough to implementation to prove the architecture works and support it through production delivery, without becoming the primary engineer for every component. You will also help shape the reusable patterns, technical standards and accelerators behind Lynx’s growing AI-native life sciences practice. KEY RESPONSIBILITIES Solution Architecture Own the end-to-end solution architecture for client engagements, including data models, system design, integration patterns and technology choices. Translate business requirements into clear technical designs and implementation paths that delivery teams can build from. Design solutions spanning enterprise data, APIs, applications, cloud platforms and GenAI capabilities. Lead technical discovery with clients: understand requirements, assess existing systems and identify dependencies, constraints and delivery risks. Present architectural options and trade-offs clearly to technical teams, business stakeholders and senior leaders. Make pragmatic decisions across build speed, cost, scalability, security and maintainability. Review key implementation decisions and remain

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 We are seeking a skilled and analytical Senior Product Analytics Associate to lead the development and execution of a data-driven product roadmap. The ideal candidate will have a deep understanding of product analytics, strong problem-solving skills, and experience working with cross-functional teams to support strategic initiatives. As a Senior Product Analytics Associate, you will work closely with cross-functional teams including engineering, product, and clinical operations. Roles and Responsibilities: Define, track, and report on product metrics including performance and profitability Build and maintain robust data transformation models using dbt (or similar frameworks like Dataform or SQL-based ETL tools) to ensure analytics-ready datasets Design and interpret A/B tests; when A/B testing is not feasible, apply causal inference methods (e.g., Diff-in-Diff, Propensity Score Matching) to determine product efficacy. Develop ROI projections for analytics projects to prioritize deliverables by business impact Tell compelling stories through data, articulating technical information to a non-technical audience Build and maintain Power BI dashboards to

POSITION SUMMARY: The Manager, Clinical Lab is a key leader in Natera’s lab operations who oversees and directs the development, planning, implementation and maintenance of manufacturing methods, processes and operations for new or existing products and technologies. The Manager works closely with groups to ensure strict compliance with good manufacturing practices and CLIA/CAP guidelines at all times. Ensures the effective use of materials, equipment and employees in producing quality products. Monitor and control staffing / labor, capital expenditures, and manufacturing performance. Develops budget and monitors expenditures. Formulates and recommends manufacturing policies, procedures and programs. Selects, develops and evaluates line-management to ensure the efficient operation of the function. PRIMARY RESPONSIBILITIES: Under the direction of Senior lab leadership, and in close collaboration with other Laboratory leadership, this individual provides operational and strategic leadership to laboratory products assigned to the individual. Generates and routinely provides executive-level production/departmental summaries. Monitors workflow and ensures production goals and deadlines are met (e.g. TAT, SLA) Engages in future planning and scales employees and equipment appropriately Gathers and monitors metrics on production deadlines, efficiency, scrap waste, and error rates Monitors the quality control/assurance programs, test results, and equipment (if applicable) Uses metrics in decision-making and to drive changes across the team (e.g. cost reduction, quality improvement) Manages sufficient headcount levels to meet production goals by proactively driving the interview process and managing employee PTO and overtime when necessary. Refines current lab process through continuous improvement projects. Oversees team-specific lab operations. Go-to person when Senior lab leadership is not present; go-to person for knowledge of pr

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 Senior Manager, Medicare Product Operations (NCOD) is responsible for providing leadership, operational oversight, and people management for the Non-Clinical Organization Determination (NCOD) team. This leader is accountable for ensuring accurate, timely, compliant, and member-centered coverage determinations while maintaining adherence to CMS regulations, and internal policies. The role oversees a team of managers and analysts responsible for evaluating member requests, issuing organization determinations, maintaining documentation, and supporting appeals- and grievance-related activities. This position serves as a key operational leader, driving quality, compliance, performance, process optimization, workforce development, and cross-functional collaboration. The Senior Manager partners with Compliance, Product, Appeals, Grievances, Eligibility, Technology, and vendor partners to ensure operational excellence and a best-in-class member experience. Responsibilities Include: Strategic Leadership Provides oversight for the NCOD operation, ensuring alignment with organizational goals, regulatory requirements, and member experience objectives. Establishes operational strategies, and performance standards that support long-term scalability and sustainability. Leads implementation of new NCOD workflo

What is PerfectServe? PerfectServe is a leading provider of clinical communication and physician scheduling solutions in the health IT space. The company was founded in 1997 and has grown steadily since then, with a notable jump after several major acquisitions were announced in 2019. PerfectServe now has 400+ employees, 30,000+ customers — spanning medical practices, hospitals, and health systems — and $100 million+ in annual revenue. PerfectServe’s mission is to accelerate speed to care by optimizing provider schedules and routing communications — including messages, pages, calls, and alerts — to the right place at the right time in any care setting. By facilitating real-time information sharing, building better schedules, and automating important clinical workflows, we believe we can help our customers advance patient care and improve the well-being of their clinicians. Leading analyst firms like Gartner® and KLAS Research have consistently validated our approach: In 2026, PerfectServe was named highest in execution and furthest in vision in the Gartner Magic Quadrant™ for Clinical Communication and Collaboration — the clear segment leader. PerfectServe also received two Best in KLAS awards in 2026 — one for physician scheduling and another for ambulatory clinical communications. That makes for 11 Best in KLAS awards over the past 9 years. At PerfectServe, you'll have a unique opportunity to join a collaborative team with decades of experience that finds new ways to delight our customers every day. This involves consistent efforts to stay on the cutting edge of product development, which includes everything from implementing AI in new and existing solutions to brainstorming with customers about novel workflows. But you don't have to be in product to make in impact — everybody at PerfectServe contributes to important work that moves the business forward. If you're looking for a well-established, tech-forward company full of smart people doing meaningful work