Responsibilities
- Stand up and run the daily clinical operations for PIN/CHI delivery
- Translate program requirements into repeatable care workflows the team can execute
- Promote healthy PIN/CHI enrollment
- Ensure billability and compliance
- Clearly define what care tasks require re-attestation
- Clearly support documentation requirements and incident-to billing rules
- Provide clinical guidelines to decline enrollment, graduate patients, etc.
- Ensure oversight cadence is clinically appropriate and operationally feasible
- Build “day in the life” playbooks for care coordination delivery
- Define the care team structure (pods, roles, coverage)
- Own supervision ratios and operating cadence (case reviews, QA, coaching)
- Ensure clear scope-of-practice boundaries across all staff
- Ensure billing-ready documentation is completed correctly every time
- Build QA routines (weekly sampling, completeness scoring, corrective actions)
- Partner with Compliance + RCM support to prevent leakage/denials caused by ops errors
- Operate a controlled pilot with volume caps and learning loops
- Track and improve KPIs: minutes delivered per member engagement + drop-off points
- Track and improve KPIs: documentation completeness
- Track and improve KPIs: time-to-first-touch and ongoing touch cadence
- Track and improve KPIs: escalation volume + resolution time
- Create onboarding and training for care team members (fast + repeatable)
- Own ongoing coaching, calibration, and performance improvement
- Define escalation pathways (urgent, safety, abuse/neglect, BH red flags)
- Ensure escalation response SLAs are met
- Partner with medical oversight as needed for care plan interpretation
- Define what the clinical team needs in the workflow/tools to execute
- Work with Product & Engineering to ensure the workflows are productized accurately
- Ensure documentation, time capture, tasking, and audit trails work in production
- Help define the “minimum viable clinical ops stack” for launch
Requirements
- Bachelor’s degree in Health Administration, Registered Nursing, or a related field
- 8+ years in operations leadership, including 5+ years in healthcare or clinical settings
- Experience with care coordination/care navigation programs (Patient Illness Navigation, Community Health Integration)
- In-depth experience with workflow design, putting together operating playbooks and performance systems to drive operational efficiency in clinical environments
- Working closely with product/engineering teams to operationalize workflows
- Experience building virtual delivery programs efficiently from the ground up in a high growth, ambiguous environment
- Knowledge of healthcare compliance and regulatory standards (e.g., HIPAA, OSHA)
- Demonstrated ability to lead high-performing teams in fast-moving & remote/distributed environments
- A collaborative leader who inspires multidisciplinary teams with empathy and clarity, drives alignment toward shared goals, and communicates effectively with stakeholders at all levels
- Proven track record of driving large scale service operations, delivering on KPIs with a high sense of urgency and service orientation, naturally relentless in overcoming barriers with speed and quality
- Skilled in leveraging data analytics to identify trends, measure performance, and inform organizational strategy and OKRs
- Passion for embedding equity, accessibility, and inclusivity into all aspects of clinical operations
Nice to Have
- A master’s degree (MBA, MPH, or MHA)
- Experience in healthtech startups
- Experience with Medicare reimbursed programs (CCM, TCM) and/or MA populations and/or longitudinal care models
Additional Information
- Location: Remote (US) / Miami preferred
- Start: ASAP
- Type: Full-time, part-time, or contract-to-hire
