Director, Clinical Operations

Job Description

It’s Time For A Change...

Your Future Evolves H ere

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. We bring our whole selves to work and we’re driven to make a difference every day, from the work we do in our roles to the charitable endeavors we support . We believe in starting by listening, communicating with candor, fostering inclusion and owning the opportunity. We respect and celebrate individual talents and team wins. Whether we’re wearing scrubs, jeans or our finest work-from-home chic, w e have fun , work hard and make time to help others .

Are we growing? Absolutely. We have seen about 30% average growth over the last three years. Are we recognized? Definitely. We were named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016, 2017, 2018 and 2019 and are proud to be recognized as a leader in driving d iversity , equity and i nclusion (D E &I) efforts . Evolent achieved a 100 % score on the 2020 Human Rights Campaign's Corporate Equality Index , making us one of the best places to work for LGBTQ+ employees. We were also named on the Best Companies for Women to Advance List 2020 by Parity.org and we publish a n annual Diversity Report to share our progress on how we’re building an equitable workplace and performing on various metrics . If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.

What You’ll Be Do ing:

Evolent Health Services is the business within Evolent that provides health plan and value-based services that can be consumed by all clients and businesses within Evolent. Within EHS , the Market Operations team owns and manages the client relationship and is accountable for driving client performance through a cross-functional, matrixed operational structure.

Reporting to the Market’s respective executive lead, the Director of Clinical Operations will have ownership and oversight of the execu tion of key clinical programs. This individual will work closely with the Evolent Clinical, Utilization Management and Pharmacy teams to set priority and identify key initiatives for clients to pursue that support quality and cost savings. This role will be responsible for mapping the required steps to put clinical initiatives into action, collaborating with functional teams across Evolent as needed. The Director of Clinical Operations will be a client facing role, serving as a trusted advisor and responsible for oversight into clinical improvement.

• Partners with clinical/program management to lead the operational planning, implementation and evaluation of clinical programs and initiatives.
• Coordinates key stakeholders o n all clinical programs both internally and externally
• Serves as a trusted advisor with the client and contributes thought leadership to client clinical counterparts

• Creates metrics, measurement, and monitoring methods for clinical, operational and economic performance of clinical program initiatives.
• Contributes to strategic planning to ensure continuous growth, improvement and innovation of clinical programs.
• Coordinates the oversight of operational-clinical integration with delegated vendors.
• Ensures compliance with regulatory requirements including NCQA, HFS, CMS and other regulatory bodies.
• Collaborates with IT leads to ensure effective and compliant implementation of clinical data and information exchange, interoperability and efficient use of software and electronic platforms.

• Manages operations staff and teams to support clinical programs, to maximize member-facing work by clinicians and other members of workforce for highest efficiency and impact.
• Hires, onboards, coaches and evaluates employees.
• Develops, prioritizes and manages hiring of overall clinical department personnel in collaboration with clinical directors.
• Develops and implements initiatives around value-based contracting around clinical initiatives in collaboration with Finance.
• Provides clinical support where needed.

• Adheres to confidentiality standards, HIPAA compliance program, and cultural competency program.
• Adheres to fraud and abuse prevention and/or detection policies and program according to regulatory requirements
• Performs other duties as assigned.
• Other duties as assigned.

The Experience You ’ll Need ( Required ):

• Bachelor’s degree in Business or related field required.
• Five (5) to Seven (7) years of industry training and increasingly responsible experience in managing midsize to large, complex health plan operations and activities
• Experience with Provider Sponsored Health Plans highly preferred
• Experience in working with State Medicaid Agencies required ; experience and knowledge of IL Medicaid policies and procedures preferred

• Knowledge of insurance industry standards
• Has strong knowledge of health plan operations ; strong understanding of provider relations and/or network development preferred
• Possesses excellent problem-solving skills
• Experience leading and mentoring team members
• Demonstrates through exceptional planning and organizational skills a record of bringing tasks and projects to successful conclusion

• Exceptional communications and interpersonal skills
• Demonstrates leadership skills with ability to work collaboratively in matrix environment to produce results across functional teams
• Demonstrates ability to develop and execute action plans to meet goals and objectives
• Demonstrates managerial and leadership abilities
• Demonstrates strong analytical, organizational and critical thinking skills

• Demonstrates ability to communicate clearly and concisely with Executive Management
• Demonstrates skills in multi-tasking and prioritizing information and projects
• Demonstrated excellent oral and written communication skills required
• Located in Cook County or a bility to travel to / and within Cook County as needed ( 10% - 50% in a post COVID-19 environment)
• Ability to multi-task in a fast pace environment; can adapt quickly to change; have strong negotiations skills

• Ability to conduct physician discussions and address escalations as needed

Technical requirements:

Currently, Evolent employees work remotely temporarily due to COVID-19. As such, we require that all employees have the following technical capability at their home: High speed internet over 10 MBPS and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.

Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.