Facility: WCO - Wellstar Corporate Office

Job Summary:

"Director of Clinical Strategy and Operations functions under the direction of the President of the Wellstar Health plan, or designee; and supports Wellstar Health Plan (WHP) executive leadership in executing Strategic Clinical Goals through the implementation of clinical and operational programs that drive optimal quality outcomes, close service gaps, as well as improve member/ provider experience/satisfaction. This leader will directly manage a growing staff of healthcare professional that may include licensed nurses, pharmacists and other staff to achieve WHP goals and objectives. The Director of Clinical Strategy and Operations oversees and is accountable for clinical, financial and quality performance of the Wellstar Health Plan, by creating strategy, tactics, and recommendations for clinical and operational programs that optimize the WHP members' care and experience. This leader leads clinical and operational programs that include both internal and/or external relationships that focus on driving high quality outcomes and provide the right care, in the right place, at the right time for WHP members. This leader utilizes clinical and claims-based data, and develops, implements, and monitors operational programs to achieve the WHP's desired outcomes, meet regulatory/compliance requirements and NCQA/URAC accreditation standards. The Director of Healthcare Strategy and operations collaborates with internal Wellstar clinical and operational leaders to develop and implement operational programs to meet common business goals; fosters and manages operational relationships with external (non-Wellstar) providers and vendors to close the service gaps for WHP members throughout the care continuum; monitors and evaluates each clinical and operational program's performance KPIs by member population, business unit or product line that it serves.

Core Responsibilities and Essential Functions:

Leads, develops, implements, and monitors evidenced-based supporting programs to drive WHP outcomes and close service gaps. a. As Commercial or Medicare contracts are initiated, this leader will partner with business units and Wellstar clinical/operations or external vendors to design, implement, and monitor clinical/operational programs based on WHP member needs and/or contracted performance guarantees. b. Develop business cases and operating models for new programs with Wellstar clinical/operational leaders or vendor solutions. c. Review and evaluate with subject matter experts, new emerging technology that supports WHP member outcomes and experience. Create business case and implement technology into operational workflows. d. Partner with external providers and vendors, community organizations and/or internal departments to identify, build and implement clinical and operational programs to close service gaps. Lead and manage the department staff in the execution of WHP strategic and operational clinical program goals. Reviews, monitors and reports on supporting programs/external vendor performance KPIs. a. Reviews clinical and operational programs to ensure compliance with state and federal regulatory guidelines by utilizing subject matter expert interpretation of insurance regulations, ERISA and CMS compliance guidelines. b. Monitors the Health Plan's participating client's clinical and operational program performance against program KPIs or performance guarantees. c. Develops executive summaries to communicate clinical and operational programs outcomes and priorities on a quarterly and annual basis. Performs other duties as assigned Complies with all Wellstar Health System policies, standards of work, and code of conduct.

Required Minimum Education:

• Bachelors Nursing or Masters Health Administration

Required Minimum License(s) and Certification(s):

All certifications are required upon hire unless otherwise stated.

• RN - Reg Nurse (Single State) or RN-COMPACT - RN - Multi-state Compact

Additional License(s) and Certification(s):

LEAN Performance Improvement for Healthcare Upon Hire Preferred

Required Minimum Experience:

Minimum 15 years Healthcare Required and Minimum 10 years Clinical and Operational Program Management Required and Minimum 7 years Progress Leadership Required and Minimum 3 years Medical Health Plan-Based and/or Value-Based Contract Program Development Required

Required Minimum Skills:

Expertise in creating presentations, executive summaries High Competency in developing clinical and operational programs and guiding performance improvement initiatives High Proficiency with Microsoft Office Suite and working with Excel spreadsheets Excellent written and verbal communication skills Strong problem-solving skills and ability to multitask Proficient in preparing and maintaining records and written reports Ability to establish and maintain effective working relationships with internal Wellstar clinical/operational partners and external providers and vendors Ability to interpret, adapt, and apply guidelines and procedures Extensive knowledge of managing patient populations, transitions in care and community resources