Note: The job is a remote job and is open to candidates in USA. Sagility is a company that combines industry-leading technology with healthcare expertise to enhance the member experience. The Program Manager – Clinical Operations will lead strategic programs and operational initiatives to improve member outcomes and optimize healthcare utilization while collaborating with various stakeholders to ensure alignment with organizational goals.
Responsibilities
- 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
- 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
- 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
- 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
- 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
- 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
- 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
Skills
- 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
- 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
Benefits
- Fully Remote
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