Director Clinical Operations & Compliance

Elevance Health • Nashville, TN

2d • Hybrid

About The Position

Director Clinical Operations & Compliance Hybrid 2: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The Clinical Operations & Compliance Director is responsible for the oversight and development of standard operating procedures (SOPs), standardizing practices across sites, and spearheading patient access and nursing strategy initiatives. The role ensures regulatory compliance and fosters cross-functional leadership to enhance the quality, safety, and efficiency of services.

Requirements

• Requires a BA/BS degree in Nursing, Healthcare Administration, Business, or a related field.
• A minimum of 5 years of experience in clinical operations, infusion therapy, ambulatory care, patient access, or a related healthcare environment with at least 3 years of leadership or management experience; or any combination of education and experience providing an equivalent background is acceptable.
• A current, valid, active unrestricted RN license in the applicable state(s) or territory of the United States is required.
• Satisfactory completion of a Tuberculosis test is mandatory for this position.

Nice To Haves

• Nurse Practitioner is highly preferred.
• Infusion therapy and/or specialty pharmacy experience are highly preferred.
• Data Literacy and Fluency, ability to use data to drive decisions and improve outcomes highly preferred.
• Project and Program Management experience, leading initiatives and implementing improvements highly preferred.
• Excellent written, oral, presentation and interpersonal communication skills with the proven ability to negotiate expectations between multiple parties strongly preferred.
• Strong nursing contracting experience, including rate and contract language negotiation highly preferred.
• Proficiency of Microsoft Office products: Excel, Teams, Outlook, PowerPoint, and Word are strongly preferred.

Responsibilities

• Develop, implement, and maintain SOPs to standardize clinical practices across all sites, ensuring safe, compliant, and efficient delivery of infusion services.
• Collaborate with clinical leaders to ensure that documentation, workflows, and care delivery meet both internal and external standards.
• Manage patient access clinical review process, including prior authorization, medical necessity review, and clinical escalation workflows.
• Manage appeals and denials to reduce avoidable occurrences and enhance reimbursement outcomes.
• Support clinical strategy development and maintain the clinical competencies of nursing staff across all sites.
• Promote the standardization of nursing practices and adherence to evidence-based quality standards.
• Collaborate with the pharmacy team to maintain and optimize the drug formulary, aligning it with clinical and financial goals.
• Partner with trade teams to support white-glove service programs and improve patient and provider experience.
• Oversee all site licensure requirements, renewals, and regulatory documentation.
• Lead internal audits and ensure readiness for external regulatory surveys and payer audits.
• Collaborate with compliance teams to monitor regulatory changes and implement corrective actions as needed.
• Work with clinical, pharmacies, revenue cycle, finance, trade, and compliance teams to support efficient operations.
• Prepare reports, dashboards, and presentations for leadership, summarizing performance metrics and strategic initiatives.
• Drive continuous improvement efforts focused on patient access, quality, safety, and operational excellence.
• Hires, trains, coaches, counsels, and evaluate performance of direct reports.

Benefits

• We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

What This Job Offers

• Job Type: Full-time
• Career Level: Director