Director, Ambulatory Care Operations

Regal Medical Group•San Bernardino, CA

4d•Remote

About The Position

The Director, Ambulatory Care Operations serves as the primary clinical and operational relationship leader between the medical network and contracted Primary Care Physicians (PCPs) across the region. This role partners closely with the Regional Medical Director, outpatient providers, care management teams, and internal operational departments to improve continuity of care, strengthen provider engagement, and enhance coordination for high-risk and high-utilizing members. The Director functions as a strategic ambulatory care integrator focused on supporting PCPs with post-discharge coordination, complex patient management, outpatient follow-up compliance, and utilization awareness. This role helps bridge communication and operational gaps between inpatient settings, outpatient providers, care management teams, and health plan resources. The Director proactively engages physician offices to improve patient outcomes, reduce avoidable utilization, support value-based care initiatives, and enhance the overall provider and patient experience. The role emphasizes relationship development, operational problem solving, provider collaboration, and proactive intervention strategies designed to strengthen outpatient care coordination across the continuum of care. This position serves as a key partner to PCP offices by ensuring providers have operational visibility into high-risk patients, recent hospitalizations, emergency room utilization, care coordination opportunities, and available organizational resources to better support their attributed members.

Requirements

Active unrestricted California Registered Nurse (RN) license.
Minimum 5 years of clinical experience.
Minimum 3 years experience in one or more of the following: Case Management, Care Coordination, Managed Care, Population Health, Utilization Management, Hospital or Ambulatory Operations.
Strong understanding of care transitions and outpatient coordination workflows.
Excellent communication, relationship-building, and organizational skills.
Ability to work collaboratively with physicians, office staff, and interdisciplinary teams.
This is a field based role.

Nice To Haves

Bachelor of Science in Nursing (BSN).
Experience in IPA, MSO, ACO, or managed care environments.
Experience working with value-based care models and population health initiatives.
Prior physician engagement or provider relations experience.
Experience with high-risk patient management and utilization reduction initiatives.
Bilingual abilities preferred based on regional needs.

Responsibilities

Develop and maintain strong working relationships with contracted PCPs, office managers, nursing staff, and outpatient clinical teams.
Serve as a primary operational liaison between PCP offices and Medical Management departments.
Conduct routine outreach, engagement meetings, and operational support visits to providers.
Support PCP alignment with organizational clinical, quality, and operational initiatives.
Facilitate communication between outpatient providers and internal departments regarding care coordination, operational barriers, and member needs.
Promote collaborative partnerships focused on improving patient outcomes and provider satisfaction.
Identify operational challenges affecting PCP offices and assist with escalation and resolution.
Support timely post-discharge follow-up appointments with PCP offices.
Facilitate communication between inpatient teams and outpatient providers following hospitalizations.
Assist PCP offices in managing recently discharged members and high-risk transitions of care.
Collaborate with Transition of Care (TOC) teams to improve continuity and reduce gaps in care.
Help identify and resolve barriers delaying outpatient follow-up or continuity services.
Monitor transition-related workflows and support process improvement initiatives.
Assist PCPs in identifying and managing high-risk, medically complex, and high-utilizing members.
Provide operational visibility into frequent ER utilizers, frequent admissions, readmission patterns, rising-risk members, and complex care coordination needs.
Collaborate with PCPs to support proactive intervention strategies for high-risk populations.
Coordinate with Case Management, Population Health, Behavioral Health, Disease Management, and Social Services teams to support member needs.
Participate in interdisciplinary case discussions and complex patient coordination efforts as appropriate.
Assist in escalating complex outpatient coordination barriers affecting patient outcomes.
Support PCP understanding of utilization trends, care gaps, and quality opportunities within their patient panels.
Assist PCPs in identifying opportunities to improve utilization, care coordination, and quality outcomes within their attributed population.
Collaborate with providers on initiatives aimed at reducing avoidable emergency room visits, readmissions, and unnecessary utilization.
Assist with provider education related to transition of care best practices, high-risk member management, preventive care opportunities, care coordination resources, and quality improvement initiatives.
Partner with internal operational teams to support value-based care strategies and population health initiatives.
Assist with implementation of operational workflows that improve outpatient coordination and patient engagement.
Support coordination between outpatient providers and internal departments including Case Management, Utilization Management, Behavioral Health, Quality Management, Population Health, Member Services, and Network Management.
Collaborate between inpatient and outpatient care teams across the continuum of care.
Assist PCP offices in navigating organizational resources and escalation pathways.
Promote integrated, patient-centered, and cost-effective care coordination practices.
Provide leadership, mentorship, and operational support to Clinical Liaison staff as assigned.
Participate in onboarding, training, and development initiatives.
Support departmental process improvement projects and operational initiatives.
Promote a culture of collaboration, accountability, responsiveness, and professionalism.
Assist leadership with identification of operational trends and opportunities for improvement.
Participate in regional clinical and operational meetings as appropriate.