California Licensed Clinical Director

Job Summary

A company is looking for a Director of Clinical Performance.

Key Responsibilities

• Ensure consistent application of clinical review criteria in authorization and review processes
• Oversee day-to-day clinical operations and maintain performance standards for authorizations, denials, and appeals
• Collaborate with medical directors and compliance to resolve complex cases and ensure adherence to regulatory requirements

Required Qualifications, Training, and Education

• Master's degree in nursing, business, or a related healthcare field preferred
• Minimum 10 years of experience in population health management
• Experience managing a team in a remote work environment
• Experience in program development and management
• Active and unrestricted license as a Registered Nurse (RN) in California is required