Regional Director of Clinical Operations

The Regional Director of Operations has end-to-end operational accountability for planning, execution, and continuous improvement of market-level Risk Adjustment (BOI), Quality (HEDIS) and Cost of Care operation programs across multiple markets. This role owns operational processes, staffing, budgets, vendor relationships, data and technology enablement, and performance outcomes. The Director partners with platform BOI/Quality, Market Medical Directors, IT/Engineering, Data & Analytics, Finance and RBEs/providers to deliver compliant, scalable, and measurable operational performance.

25% annual trave

l

Essential Job Function

s:Operational Leadership & Execution – 4

5%• Lead and operationalize BOI, Quality and Cost of Care programs across 3+ markets; develop and enforce SOPs, SLAs and RACI for all program activitie

s.• Collaborate with Central Operations to manager operation, performance and outcomes related to pre-visit record review, post-visit coding review, chart collection, query workflows and provider engagement processe

s.• In close partnership with the Market Leader and market operations team, oversee market operations, monitor performance, and implement corrective action and performance improvement plan

s.• Define operational KPIs, run root cause analysis, lead process improvement efforts and institutionalize best practices across market

s.• Serve as the escalation point for market operational issues and lead cross-functional readiness for new initiative

s.• Provide oversight of operating budgets for BOI/Quality (labor, contractors, vendor spend); forecast resource needs and identify cost-to-serve improvement

s.

Data & Technology Ownership –

35%• Partner with Data & Analytics and IT/Engineering to define technical requirements, data pipelines, EMR/claims integrations, and dashboards to support risk capture and quality improveme

nt.• In partnership with Tech, innovate on and participate in testing of solutions that drive automation and technology enablement to reduce manual effort and increase operational sc

ale

People & Capacity –

20%• In collaboration with and informed by input from the Regional President, lead capacity planning, staffing models, recruitment, training and performance management for market BOI/Quality operati

ons.

Required Qualificat

ions:1. Minimum Exper

ienceo 5+ years healthcare operations experience; 3+ years leading multi-market risk adjustment or quality pro

grams2. Education/Licen

sure:o Bachelor’s degree required; advanced degree pref

erredo Six Sigma/Lean certification pref

erred

Skills and Abil

ities:1. Solid knowledge of HEDIS, risk adjustment coding and healthcare data (claim

s/EMR)2. Demonstrated management of operational teams and vendor pa

rtners3. Analytics fluency (dashboards/KPI’s and either direct SQL or close collaboration with analytics

teams)4. Proven program and project management skills and process improvement expe

rience5. Language Skills: Strong communication skills both written and verbal to work with multiple internal and external clients in a fast-paced envir

onment6. Mathematical Skills: Ability to work with mathematical concepts such as probability and statistical inference. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situa

tions.7. Reasoning Ability: Ability to apply principles of logical or scientific thinking to a wide range of intellectual and practical pro

blems.8. Computer Skills: Ability to create and maintain documents using Microsoft

Office