Program Manager - Clinical Operations

Collaborate with clinical leadership to improve care management workflows and operational processes.

Drive initiatives focused on reducing avoidable admissions, readmissions, emergency department utilization, and total cost of care.

Support implementation and enhancement of clinical programs targeting high-risk and complex populations.

Ensure operational readiness for new client implementations, program expansions, and process transformations.

Support value-based care initiatives through performance monitoring and outcome improvement strategies.

Utilize healthcare analytics to identify care gaps, risk trends, utilization patterns, and intervention opportunities.

Partner with quality and clinical teams to improve HEDIS, STAR, and other quality performance measures.

Monitor key population health metrics and recommend improvement actions.

Serve as a primary point of contact for internal and external stakeholders.

Facilitate collaboration across clinical, operational, technology, quality, and analytics teams.

Present program performance, operational updates, risks, and recommendations to leadership and clients.

Build strong relationships with healthcare payer, provider, and care management stakeholders.

Ensure adherence to NCQA, CMS, HIPAA, URAC, and client-specific requirements.

Support audit readiness and regulatory compliance activities.

Monitor operational quality metrics and implement corrective action plans when necessary.

Promote a culture of continuous quality improvement.

Develop and monitor KPIs, operational dashboards, and program scorecards.

Analyze trends related to productivity, utilization, quality outcomes, and member engagement.

Identify opportunities for operational optimization through data-driven decision-making.

Provide executive-level reporting and actionable insights.

Identify program risks, operational challenges, and process gaps.

Develop mitigation strategies and manage change initiatives across teams.

Ensure effective communication and stakeholder engagement throughout program implementation.

Program & Portfolio Management

Clinical Operations Leadership

Population Health Management

Utilization & Care Management

Value-Based Care Strategy

Healthcare Analytics & Reporting

Process Improvement & Operational Excellence

Stakeholder & Client Management

Regulatory Compliance

Change Management

Strategic Thinking & Problem Solving

Program delivery within scope, timeline, and budget.

Improvement in care management and utilization outcomes.

Reduction in avoidable admissions and readmissions.

Enhanced quality measure performance (HEDIS, STAR, CMS metrics).

Client satisfaction and operational performance targets.

Operational efficiency and productivity improvements.

Compliance and audit readiness outcomes.