Director Clinical Operations (RN)

The Director of Clinical Operations will provide leadership for Telligen's comprehensive population health management programs, including strategic direction for accredited care management, utilization management, disease management, and wellness initiatives across multiple states and clients. This role is crucial in driving clinical excellence and operational efficiency while ensuring alignment with client objectives.

• Strategic Leadership & Program Management - Directs, innovates, and optimizes population health management programs. Develops and implements evidence-based clinical programs aligned with NCQA and URAC standards. Drives integration of care management solutions across the care continuum. Establishes and monitors program effectiveness through quality metrics and outcomes measurement. Leads innovation in care delivery models and digital health integration.
• Financial & Business Development - Develops and manages program budgets and resource allocation. Drives cost-effectiveness while maintaining quality outcomes. Participates in RFP responses and business development initiatives. Analyzes program ROI and value proposition for stakeholders. Evaluates contractual and programmatic requirements associated with new clients and successfully onboards them into HWB programs.
• Clinical Excellence & Innovation - Ensures compliance with clinical guidelines, contractual agreements, and regulatory requirements. Develops and implements clinical protocols and pathways. Fosters relationships with key stakeholders including clients, providers, payers, brokers, consultants, and across intercompany divisions. Leads quality improvement initiatives and best practice implementation. Delivers measurable outcomes consistent with client expectations and contractual requirements.
• Team Leadership - Builds and mentors high-performing clinical teams. Drives performance management and professional development. Ensures appropriate staffing models and resource allocation. Fosters a culture of continuous improvement and innovation.
• Other Duties - Represents the Company at meetings with clients, partners, stakeholders, community and business leaders. Makes presentations ensuring a professional and knowledgeable image is projected. Leads quality and accreditation audits. Researches potential business opportunities and provides subject matter expertise in proposal development. Performs miscellaneous duties as assigned.

Required Qualifications:

• Current and unrestricted RN license required.
• Bachelors of Science in Nursing required.
• 8+ years of progressive healthcare management experience.
• 5+ years of direct management experience in population health or managed care.
• Experience with NCQA and/or URAC accreditation processes.
• Proven track record in program development and implementation.
• Strong analytical and financial management skills.

Preferred Qualifications:

• 3+ years of Director-level experience.
• Knowledge of product development.
• Background in leading quality improvement methodologies.
• Experience in managed care.
• Case Management Certification (CCM, ACM, or equivalent).
• Experience in participating in business development processes and drafting responses to requests for proposals.