Clinical Services Director

Adobe Care And Wellness LLC•Phoenix, AZ

1d•Hybrid

About The Position

Adobe Population Health (APH) is a women-owned health solutions company founded in 2018 with a mission of positively impacting the lives we touch. Headquartered in Phoenix, AZ, with satellite locations across multiple states, APH fosters a culture rooted in inclusivity, human kindness, and high-quality care. Recognized by Inc. 5000 as one of America’s Fastest-Growing Private Companies and honored for a fifth consecutive year as a “Best Place to Work” by the Phoenix Business Journal, APH continues to expand its reach and impact. APH partners with health plans, providers, hospitals, and families to deliver tailored programs including case management, in-home and in-clinic wellness assessments, preventative care, transitional care, and social services. As one of the nation’s few fully integrated healthcare organizations, APH delivers comprehensive, coordinated medical and social support through a wide range of specialized service lines. With continued growth on the horizon, APH is seeking mission-driven individuals who are passionate about improving health outcomes and supporting those in need.

Requirements

Seven (7) years of progressive clinical and healthcare setting experience.
Five (5) years of experience in population health, home health, value-based care, managed care, risk adjustment, or a related space.
Three (3) years of management experience overseeing clinical teams and operations.
In-depth knowledge of CMS guidelines and the HCC Risk-Adjustment Model.
Experience working with and understanding of STARS/HEDIS measures.
Experience in implementing new structures, processes, and roles in support of rapidly shifting business demands.
Experience leading and managing teams, with strong leadership, coaching, and mentoring skills.
Demonstrated experience overseeing teams across multiple states, service lines, or regulatory environments.
Demonstrated ability to lead organizational change and foster a culture of accountability and continuous improvement.
Excellent analytical and problem-solving abilities, with a keen eye for detail.
Strong interpersonal and communication skills, capable of interacting with individuals at all levels of the organization.
Proven track record of implementing successful quality improvement initiatives and driving organizational change.
Master's Degree in Nursing (MSN), Advanced Practice Nursing, or related healthcare field.
Current and unrestricted Nurse Practitioner license in Arizona.
Current DEA registration (if applicable).
Willingness to obtain and maintain additional state licenses as required by business needs.

Responsibilities

Provide strategic and operational leadership for all Clinical Assessment Services programs, including In-Home Risk Assessments, Telehealth Risk Assessments, Risk Adjustment initiatives, Clinical documentation improvement efforts, and Nurse Practitioner operations.
Establish clinical standards, workflows, and best practices to ensure consistent delivery of high-quality care.
Ensure all clinical services align with organizational objectives, regulatory requirements, contractual obligations, and industry best practices.
Serve as a clinical resource and subject matter expert for Nurse Practitioners, clinical leaders, and operational teams.
Collaborate with Medical Directors, Quality, Compliance, Operations, and Provider Engagement teams to drive organizational success.
Identify opportunities to improve patient outcomes, operational efficiencies, member satisfaction, and clinical performance.
Provide direct oversight and support to the Nurse Practitioner Manager and NP teams.
Lead recruitment, onboarding, training, mentoring, retention, and succession planning efforts for clinical staff.
Conduct performance evaluations, competency assessments, coaching sessions, and corrective action plans as needed.
Develop and implement ongoing education programs focused on Risk Adjustment, HCC Documentation, Clinical Documentation Improvement (CDI), CMS Regulations, Medicare Advantage requirements, and Population Health best practices.
Foster a culture of accountability, engagement, collaboration, and continuous learning.
Ensure staffing models appropriately support business needs and growth objectives.
Lead Risk Adjustment strategies to improve coding accuracy, documentation integrity, and HCC capture.
Develop and execute Risk Adjustment improvement initiatives and remediation plans.
Identify documentation gaps through chart reviews, audits, and data analysis.
Partner with providers and clinical teams to improve suspect closure rates, coding accuracy, documentation quality, and chronic condition management.
Develop tools, dashboards, and reporting mechanisms to monitor Risk Adjustment performance.
Educate clinical teams on CMS Risk Adjustment methodologies and documentation requirements.
Ensure Risk Adjustment initiatives align with contractual performance metrics and organizational goals.
Participate fully in the Quality Assurance Performance Improvement (QAPI) program and other quality initiatives.
Ensure compliance with CMS regulations, Medicare Advantage requirements, Medicaid requirements, State and federal healthcare regulations, HIPAA requirements, and Accreditation standards.
Lead clinical audits, workflow reviews, and quality assessments.
Develop corrective action plans and monitor improvement efforts.
Identify and mitigate clinical, operational, and compliance risks.
Collaborate with Quality and Compliance teams to prepare for audits, accreditation reviews, and regulatory assessments.
Establish strategic goals and operational objectives aligned with organizational priorities.
Develop and monitor key performance indicators (KPIs) related to productivity, clinical quality, patient outcomes, Risk Adjustment performance, member satisfaction, and provider satisfaction.
Analyze performance data and implement process improvement initiatives.
Develop and maintain policies, procedures, workflows, and operational standards.
Monitor departmental budgets, staffing resources, and operational performance.
Communicate departmental performance, challenges, and opportunities to executive leadership.
Support organizational growth initiatives and expansion into new markets.
Conduct in-home assessments and clinical visits as needed to support operations, training, quality initiatives, and business continuity.
Ensure timely identification and intervention for urgent and emergent patient situations.
Promote patient-centered care and positive health outcomes.
Collaborate with providers, caregivers, community resources, and interdisciplinary teams to improve care coordination.
Support care gap closure initiatives and preventative health programs.
Develop strong relationships with Medical Directors, Providers, Health Plans, Clinical Staff, Operations Leaders, and Community Partners.
Serve as a liaison between clinical operations and organizational leadership.
Participate in organizational committees, workgroups, and strategic initiatives.
Promote a culture of collaboration and shared accountability.
Maintain professional competence through continuing education, certifications, conferences, and industry engagement.
Stay informed of emerging healthcare trends, CMS regulations, Risk Adjustment updates, and population health best practices.
Contribute to innovation and continuous improvement across the organization.
Perform other duties as assigned.