Clinical Program Director

Job Summary

A company is looking for a Clinical Program Director.

Key Responsibilities

• Monitor utilization trends and identify clinical drivers of unnecessary inpatient admissions and operational inefficiencies
• Design targeted programs to improve medical necessity decision-making and reduce unnecessary inpatient admissions
• Define and evolve the clinical framework to ensure alignment with evidence-based guidelines and payer strategic priorities

Required Qualifications

• 10+ years of experience in inpatient utilization management at a health plan or inpatient revenue integrity at a hospital
• Clinical degree (e.g., RN, MD, PharmD) preferred but not required
• Proven track record in designing and overseeing clinical programs that impact inpatient utilization and spend
• Strong understanding of inpatient utilization, regulatory requirements, and clinical guidelines
• Experience collaborating with cross-functional teams to translate clinical strategy into actionable plans