项目经理 - 临床运营
Program Manager - Clinical Operations
Sagility 将行业领先的科技与以变革为导向的BPM服务，结合数十年的医疗健康领域专业知识，帮助客户更贴近其会员。公司通过临床、个案管理、会员参与、供应商解决方案、支付准确性、理赔成本控制和分析等服务，优化整个会员/患者体验。Sagility 在5个国家拥有超过25,000名员工。
Program Manager 将与临床领导者、医生、护士、照护管理者、运营团队、分析团队和客户利益相关者紧密合作，以改善会员结果、优化医疗资源使用并提升运营效率。职位名称：
Program Manager - 临床运营 职位描述：
职位概述
临床运营项目经理负责领导支持个案管理、资源管理、照护协调、人群健康和基于价值的护理服务的战略项目和运营计划。该角色将推动项目执行、运营卓越、质量改进和绩效成果，同时确保与组织目标和客户期望保持一致。
临床运营项目经理将与临床领导者、医生、护士、照护管理者、运营团队、分析团队和客户利益相关者紧密合作，以改善会员结果、优化医疗资源使用并提升运营效率。
主要职责
项目领导与执行
- 负责临床运营项目的全流程管理，包括规划、实施、监控和优化。
- 管理多个支持个案管理、资源管理、护理过渡、慢性病管理和人群健康计划的工作流。
- 建立项目治理结构、项目计划、里程碑和绩效指标。
- 确保战略计划按时交付，同时满足质量、运营和财务目标。
临床运营管理
- 与临床领导者合作，改进个案管理流程和运营流程。
- 推动减少可避免的住院、再入院、急诊科使用和整体医疗成本的举措。
- 支持针对高风险和复杂人群的临床计划的实施和优化。
- 确保新客户实施和项目扩展的运营准备就绪。
查看英文原文
Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.
The Program Manager will partner closely with clinical leaders, physicians, nurses, care managers, operations teams, analytics teams, and client stakeholders to improve member outcomes, optimize healthcare utilization, and enhance operational efficiency.Job title:
Program Manager - Clinical OperationsJob Description:
Position Summary
The Program Manager – Clinical Operations is responsible for leading strategic programs and operational initiatives supporting Care Management, Utilization Management, Care Coordination, Population Health, and Value-Based Care services. This role will drive program execution, operational excellence, quality improvement, and performance outcomes across clinical operations while ensuring alignment with organizational goals and client expectations.
The Program Manager will partner closely with clinical leaders, physicians, nurses, care managers, operations teams, analytics teams, and client stakeholders to improve member outcomes, optimize healthcare utilization, and enhance operational efficiency.
Key Responsibilities
Program Leadership & Execution
- Lead end-to-end management of clinical operations programs, including planning, implementation, monitoring, and optimization.
- Manage multiple workstreams supporting care management, utilization management, transitions of care, chronic disease management, and population health initiatives.
- Establish program governance, project plans, milestones, and performance metrics.
- Ensure timely delivery of strategic initiatives while meeting quality, operational, and financial objectives.
Clinical Operations Management
- Collaborate with clinical leadership to improve care management workflows and operational processes.
- Drive initiatives focused on reducing avoidable admissions, readmissions, emergency department utilization, and total cost of care.
- Support implementation and enhancement of clinical programs targeting high-risk and complex populations.
- Ensure operational readiness for new client implementations, program expansions, and process transformations.
Population Health & Value-Based Care
- Support value-based care initiatives through performance monitoring and outcome improvement strategies.
- Utilize healthcare analytics to identify care gaps, risk trends, utilization patterns, and intervention opportunities.
- Partner with quality and clinical teams to improve HEDIS, STAR, and other quality performance measures.
- Monitor key population health metrics and recommend improvement actions.
Stakeholder & Client Management
- Serve as a primary point of contact for internal and external stakeholders.
- Facilitate collaboration across clinical, operational, technology, quality, and analytics teams.
- Present program performance, operational updates, risks, and recommendations to leadership and clients.
- Build strong relationships with healthcare payer, provider, and care management stakeholders.
Quality & Regulatory Compliance
- Ensure adherence to NCQA, CMS, HIPAA, URAC, and client-specific requirements.
- Support audit readiness and regulatory compliance activities.
- Monitor operational quality metrics and implement corrective action plans when necessary.
- Promote a culture of continuous quality improvement.
Performance Management & Analytics
- Develop and monitor KPIs, operational dashboards, and program scorecards.
- Analyze trends related to productivity, utilization, quality outcomes, and member engagement.
- Identify opportunities for operational optimization through data-driven decision-making.
- Provide executive-level reporting and actionable insights.
Risk & Change Management
- Identify program risks, operational challenges, and process gaps.
- Develop mitigation strategies and manage change initiatives across teams.
- Ensure effective communication and stakeholder engagement throughout program implementation.
Required Qualifications
- Bachelor's degree in Healthcare Administration, Nursing, Public Health, Life Sciences, Business Administration, or a related field.
- 7+ years of experience in healthcare operations, care management, utilization management, population health, or clinical program management.
- 3+ years of experience leading cross-functional programs or large-scale operational initiatives.
- Strong understanding of healthcare payer and provider operations.
- Experience working with clinical and operational performance metrics.
Preferred Qualifications
- Master's degree (MBA, MHA, MPH, MSN, or equivalent).
- PMP, Lean Six Sigma, PMP, or Healthcare Quality certifications.
- Experience with Value-Based Care, Risk Adjustment, Population Health Management, HEDIS, STAR Ratings, or Care Management programs.
- Familiarity with EMR/EHR systems, care management platforms, and healthcare analytics tools.
Core Competencies
- Program & Portfolio Management
- Clinical Operations Leadership
- Population Health Management
- Utilization & Care Management
- Value-Based Care Strategy
- Healthcare Analytics & Reporting
- Process Improvement & Operational Excellence
- Stakeholder & Client Management
- Regulatory Compliance
- Change Management
- Strategic Thinking & Problem Solving
Key Performance Indicators (KPIs)
- Program delivery within scope, timeline, and budget.
- Improvement in care management and utilization outcomes.
- Reduction in avoidable admissions and readmissions.
- Enhanced quality measure performance (HEDIS, STAR, CMS metrics).
- Client satisfaction and operational performance targets.
- Operational efficiency and productivity improvements.
- Compliance and audit readiness outcomes.
Sagility is an Equal Opportunity Employer/Vet/Disability
Location:
Work@Home USAUnited States of AmericaOriginally posted on Himalayas