Senior Director, Clinical Services

HealthCare Partners, IPA and HealthCare Partners, MSO together comprise our health care delivery system providing enhanced quality care to our members, providers and health plan partners. Active since 1996, HealthCare Partners (HCP) is the largest physician-owned and led IPA in the Northeast, serving the five boroughs and Long Island. Our network includes over 6,000 primary care physicians and specialists delivering services to our 125,000 members enrolled in Commercial, Medicare and Medicaid products. Our MSO employs 165+ skilled professionals dedicated to ensuring members have access to the highest quality of care while efficiently utilizing healthcare resources.

HCP’s vision is to be recognized by members, providers and payers as the organization that delivers unsurpassed excellence in healthcare to the people of New York and their communities. We pride ourselves on selecting the most qualified candidates who reflect HCP’s mission of serving our members by facilitating the delivery of quality care. Interested in joining our successful Garden City Team?
Position Summary: The Senior Director, Clinical Services serves as a key leader within the Clinical Services division, functioning as the principal operational and clinical partner to the Senior Vice President, Clinical Services. This role combines strategic leadership, clinical oversight, operational execution, regulatory compliance, and organizational effectiveness to ensure the successful performance of all Clinical Services functions.

The Senior Director is responsible for translating organizational priorities into actionable plans, driving cross-functional initiatives, optimizing departmental performance, and ensuring alignment with corporate, health plan, regulatory, and accreditation requirements. The incumbent provides leadership for Utilization Management (UM), Care Management, Population Health, Special Needs Plan (SNP) Model of Care activities, and other Clinical Services operations while fostering collaboration across departments and external stakeholders.

The Senior Director serves as a trusted advisor to the SVP, Clinical Services, providing strategic counsel, operational leadership, executive-level project management, and oversight of key clinical initiatives that support quality outcomes, regulatory compliance, financial performance, and member satisfaction.

Essential Position Functions/Responsibilities:

• Serve as the primary operational and clinical partner to the Senior Vice President, Clinical Services, providing leadership, consultation, and execution support across all Clinical Services functions.
• Ensures strategic priorities, initiatives, and organizational goals are effectively coordinated and executed.
• Lead the development, implementation, monitoring, and continuous improvement of departmental goals, objectives, policies, procedures, and operational plans.
• Drive organizational effectiveness through performance management, process improvement, change management, and operational excellence initiatives.
• Coordinate and manage executive-level projects, strategic initiatives, and cross-functional workstreams on behalf of the SVP.
• Responsible for ensuring IRR completion by all clinical staff within the department
• Prepare executive presentations, dashboards, scorecards, reports, and analyses for senior leadership, health plans, committees, and regulatory agencies.
• Facilitate leadership meetings, action planning sessions, and strategic planning activities for the Clinical Services division.
• Provide oversight and direction for Utilization Management, Care Management, Population Health, Special Needs Plan (SNP) activities, and other clinical operations.
• Ensure Clinical Services programs operate in accordance with organizational goals, contractual obligations, regulatory requirements, and accreditation standards.
• Promote integration and collaboration among Utilization Management, Care Management, Quality Improvement, Population Health, Provider Relations, and other operational departments.
• Monitor clinical performance metrics, utilization trends, quality indicators, and operational outcomes to identify opportunities for improvement.
• Support the implementation of evidence-based practices and innovative care management strategies that improve member outcomes and reduce unnecessary utilization.
• Provide senior level oversight for all Utilization Management activities and personnel.
• Direct the development, implementation, evaluation, and ongoing enhancement of UM policies, procedures, and program infrastructure.
• Maintain responsibility for the UM Program Description, Annual Work Plan, Annual Program Evaluation, and associated regulatory reporting.
• Ensure UM activities are compliant with NCQA accreditation standards, CMS requirements, state regulations, health plan contracts, and organizational policies.
• Review utilization trends, denial patterns, appeals, grievances, and authorization metrics to ensure program effectiveness and compliance.
• Oversee preparation and submission of delegated UM reports and performance metrics to contracted health plans and regulatory entities.
• Ensure timely and accurate UM, QI, and MAC Committee operations, including agenda development, meeting facilitation, documentation, and reporting.
• Serve as a subject matter expert regarding NCQA standards, CMS regulations, managed care requirements, and delegated entity oversight.
• Lead organizational readiness efforts for NCQA accreditation reviews, audits, delegated oversight evaluations, and regulatory examinations.
• Monitor performance improvement activities and lead initiatives designed to improve clinical outcomes, member experience, and operational efficiency.
• Ensure compliance with all applicable federal, state, and contractual requirements governing clinical operations.
• Partner with Compliance, Quality Improvement, and Risk Management teams to address identified gaps and implement corrective action plans.
• Support implementation and execution of the Special Needs Plan Model of Care.
• Facilitate and oversee Model of Care training programs and compliance requirements.
• Provide leadership, coaching, mentorship, and professional development to Clinical Services management and staff.
• Establish performance expectations and accountability measures aligned with organizational objectives.
• Lead workforce planning, recruitment, retention, succession planning, and employee engagement initiatives.
• Ensure appropriate staffing models and resource allocation to support operational performance and growth.
• Participate in hiring, disciplinary actions, performance management, and termination decisions as necessary.
• Ensure alignment and integration between Utilization Management, Care Management, Quality Improvement, and Population Health initiatives.
• Participate in interdisciplinary care team meetings and population health strategy discussions.
• Monitor performance improvement activities and lead initiatives designed to improve clinical outcomes, member experience, and operational efficiency.
• Support implementation and ongoing monitoring of quality and value-based care initiatives.
• Lead special projects, strategic initiatives, and enterprise-wide programs as assigned by the Senior Vice President, Clinical Services.
• Perform other duties as required to support organizational goals and objectives.

Qualification Requirements:
Skills, Knowledge, Abilities

• Extensive knowledge of Utilization Management, Care Management, Population Health, and Quality Improvement principles.
• Expert knowledge of NCQA standards, CMS requirements, managed care regulations, delegated oversight, and accreditation processes.
• Strong strategic planning, organizational leadership, and operational management capabilities.
• Exceptional executive presence, communication, presentation, and relationship-building skills.
• Advanced analytical, critical thinking, and problem-solving abilities.
• Demonstrated ability to influence across all levels of an organization and lead through collaboration.
• Ability to manage multiple priorities in a fast-paced, highly regulated environment.
• Strong financial acumen and understanding of healthcare operations and performance metrics.
• Proficiency with healthcare analytics, reporting tools, and clinical information systems.

Training/Education:

• Current unrestricted Registered Nurse (RN) license required.
• Bachelor of Science in Nursing (BSN) required.
• Master's degree in Nursing, Healthcare Administration, Public Health, Business Administration, or related healthcare field required.
• Certified Case Manager (CCM) required.
• NCQA Accreditation/Delegation experience required.
• Additional certifications in healthcare management, quality, utilization management, or population health preferred.

Experience:

• Minimum of 10 years of progressive leadership experience in healthcare operations, clinical services, utilization management, care management, or managed care.
• Minimum of 5 years of senior leadership experience in managed care, health plan, IPA, MSO, ACO, or risk-bearing healthcare organizations.
• Demonstrated experience leading Utilization Management, Care Management, Quality Improvement, and population health programs.
• Experience serving in a highly visible leadership role supporting executive-level decision making and organizational strategy.
• Proven success managing cross-functional teams, regulatory compliance, accreditation activities, and operational transformation initiatives.
• Experience with specialty pharmacy and high-cost medication management preferred

Base Compensation: $165,000 - $190,000 annually
Bonus Incentive: Eligibility based off organizational performance
Benefits: Fully paid Medical & Dental employee coverage + robust benefits package (PTO, 401k, FSA, Tuition Reimbursement, etc.)

Equal Employment Opportunity Statement:
HealthCare Partners, MSO is committed to fostering a diverse and inclusive workplace. We provide equal employment opportunities (EEO) to all employees and applicants without regard to race, color, religion, sex, national origin, age, disability, genetics, or any other protected status under federal, state, or local laws. In compliance with all applicable laws, HealthCare Partners, MSO upholds a strict non-discrimination policy in every location where we operate. This policy applies to all aspects of employment, including but not limited to recruitment, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

Job Disclaimer:
The above job description outlines the general scope and responsibilities of the position. It is not intended to be an exhaustive list of duties, skills, or qualifications required. Responsibilities may evolve based on business needs.