Clinical Operations Consultant

Austin, TX, US • Posted 3 hours ago • Updated 3 hours ago
Full Time
On-site
Fitment

Dice Job Match Score™

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Job Details

Skills

  • Global Delivery
  • Health Care
  • Workflow
  • Customer Facing
  • Communication
  • Leadership
  • Utilization Management
  • Process Modeling
  • Management
  • Customer Engagement
  • Innovation
  • Collaboration
  • Analytics
  • Artificial Intelligence
  • Decision-making
  • HIPAA
  • Auditing
  • Regulatory Compliance
  • Military
  • Law

Summary

Job Description

The ideal candidate understands how payers operate across the healthcare continuum, how global delivery models function, and how clinical teams partner with technology and analytics to modernize workflows.


Qualifications

  • Active U.S. Registered Nurse (RN) license
  • 13+ years of experience, including 8 10 years in payer/provider operations (utilization management, care management, claims)
  • Experience in clinical workflow design, operations, or audits in healthcare environments
  • Knowledge of payment integrity, risk adjustment, or CDI (preferred)
  • Strong understanding of healthcare regulations (CMS, NCQA, URAC, HIPAA)
  • Exposure to digital/AI tools and workflow automation
  • Strong leadership, client-facing, and communication skills
  • Proven ability to operate in fast-paced, dynamic environments


Key Responsibilities

  • Operational Leadership: Lead global clinical operations ensuring delivery excellence in utilization management, care coordination, claims, and payment integrity.
  • Solution & Process Design: Design scalable operating models for care management, triage, and cost-of-care programs
  • Client Engagement: Serve as a trusted advisor to clients, guiding strategy, quality, and performance discussions.
  • Innovation & Enablement: Collaborate with technology and analytics teams to embed AI and digital solutions that enhance decision-making, compliance, and patient outcomes.
  • Regulatory & Compliance: Ensure adherence to CMS, NCQA, URAC, and HIPAA standards, maintaining audit readiness and mitigating compliance risks.


Our client is an Equal Opportunity Employer, committed to a workplace free from discrimination and harassment. Employment decisions are based on business needs, job requirements, and individual qualifications without regard to race, color, religion, gender, age, disability, sexual orientation, gender identity, marital status, military service, genetic information, or any other status protected by law.

Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.
  • Dice Id: zipfeed
  • Position Id: 976c2a7f00c54660
  • Posted 3 hours ago
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