Director of Clinical Operations

Personify Health • Tempe, AZ

2d

About The Position

Because health is personal. That's why Personify Health created the first and only personalized health platform—bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one place. We serve employers, health plans, and health systems with data-driven solutions that reduce costs while actually improving health outcomes. Together, our team is on a mission to empower people to lead healthier lives.
Learn even more about the work that drives us at personifyhealth.com.

Requirements

• Basic computer literacy
• The ability to work on multiple screens, and proficient typing skills.
• Proficiency in software applications including, but not limited to, Microsoft Word, Microsoft Excel, and Outlook
• Ability to speak clearly and convey complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others.
• Ability to work independently and utilize written resources to problem solve.
• Training and understanding of AI tools like copilot and Claude helpful with the ability to learn and adapt technologies as they become available.
• Teams on and off camera, SharePoint, Drives as needed, VPN, UM Web or Health Notes, El Dorado, Quick Links, GIAS, ADP, Confluence, Phone system with headset, Smartsheet—there may be additional programs as it relates to particular job duties
• Knowledge of medical claims and ICD-10, CPT, HCPCS coding
• Excellent verbal and written communication skills for upward and downward conversations
• Knowledgeable of the Federal, State and ERISA regulations
• Strong operational knowledge of UM, CM, and disease management workflows
• Effective people management and coaching skills
• Ability to manage daily operational priorities and competing demands
• Clear, consistent communication with clinical and non‑clinical teams
• Advanced performance analysis and operational problem‑solving
• Ability to translate strategy into scalable workflows and metrics
• Strong partnership skills across compliance, medical, and operational teams
• Comfort leading through change and complexity
• Enterprise‑level operational leadership and systems thinking
• Visionary leadership with strong execution discipline
• Ability to align clinical operations with financial, regulatory, and strategic goals
• Executive presence and influence
• Active, unrestricted Registered Nurse (RN) license
• Associate or Bachelor’s degree in Nursing required
• Minimum 4–6 years of experience in UM, CM, DM, or hospital-based care management
• Prior people management experience strongly preferred
• Active, unrestricted RN license
• Bachelor’s degree required; Master’s degree preferred
• 6–9+ years of progressive leadership experience in Care Management operations
• Demonstrated success leading multi‑team or multi‑program operations
• Active, unrestricted RN license
• Bachelor’s degree required; Master’s degree strongly preferred
• 10+ years of senior leadership experience in managed care operations
• Proven enterprise leadership across UM, CM, and population health programs
• Ability to perform the essential job functions safely and successfully with or without reasonable accommodation, including meeting qualitative and/or quantitative productivity standards.
• Ability to maintain regular, punctual attendance.
• Ability to sit for 6-8 hours.
• Constant use of computer keyboard and mouse; repetitive use of both hands.
• Occasional to frequent twisting of neck; occasional bending of neck and at waist.

Nice To Haves

• Certification in Case Management or Utilization Review preferred
• Experience across multiple product lines (self‑funded, fully insured, Medicaid, Medicare) preferred

Responsibilities

• Oversee day‑to‑day clinical operations for UM, CM, and DM teams.
• Ensure operational workflows meet productivity, quality, and turnaround time expectations.
• Monitor staff performance, workload distribution, and case activity metrics.
• Address operational barriers and escalate systemic issues as appropriate.
• Supervise managers and/or clinical leads within Care Management.
• Participate in hiring, onboarding, training, coaching, and performance management.
• Foster team engagement and accountability while supporting consistent application of policies and procedures.
• Ensure care management decisions align with clinical criteria, plan language, and medical policy.
• Support clinical components of cost management strategies and utilization optimization.
• Maintain readiness for clinical operations components of NCQA and URAC reviews.
• Partner with the VP of Care Management on operational priorities and process improvements.
• Communicate clinical updates, policy changes, and operational expectations to teams.
• Lead operational strategy across UM, CM, and population health programs.
• Analyze utilization, quality, and outcome data to identify performance trends and opportunities.
• Drive consistency and standardization across teams, states, and client populations.
• Ensure care management operations are scalable and aligned with growth strategies.
• Oversee implementation and optimization of care management workflows, tools, and technologies.
• Partner with Compliance and Medical Directors to operationalize regulatory and clinical requirements.
• Lead corrective actions resulting from audits, performance reviews, or operational risk assessments.
• Serve as a clinical operations subject matter expert for senior leadership.
• Provide input into strategic planning, budgeting, and staffing models.
• Mentor care management leaders and build leadership bench strength.
• Set the long‑term vision for Care Management operations across products, clients, and lines of business.
• Ensure operational excellence across UM, CM, and population health programs at scale.
• Balance quality outcomes, member experience, regulatory readiness, and cost stewardship.
• Lead enterprise initiatives related to care model evolution, automation, and performance optimization.
• Sponsor cross‑functional initiatives that improve care coordination, utilization outcomes, and member impact.
• Ensure Care Management operations support client retention, growth, and differentiation.
• Partner closely with executive leadership, Medical Directors, Compliance, Finance, and Client Services.
• Represent Care Management Operations in enterprise governance, audits, and client discussions.
• Develop future leaders and ensure succession planning for operational leadership roles.

Benefits

• Competitive base salary and benefits effective day one
• Comprehensive medical and dental through our own health solutions (yes, we use what we build)
• Unlimited PTO—rest and recharge time is non-negotiable
• Mental health support, retirement planning, and financial protection
• Professional development with clear career progression and learning budgets
• Mission-driven culture where diverse perspectives drive real impact on people's health

What This Job Offers

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