McLaren Health Care · 3 weeks ago
Clinical Director, Health Plan Operations RN, Michigan
Flint, MI
Full-time
Hybrid
Director/Executive
10+ years expMcLaren Health Care is a Managed Care Organization dedicated to meeting the health care needs of its members. They are seeking a Clinical Director to manage health services and medical management activities, ensuring compliance with standards and overseeing staff training and policy implementation.
Health CareHospitalMedicalOncologyRehabilitation
Responsibilities
Provides overall management and direction for the assigned Plan's health services and medical management activities to meet organizational goals
Assumes responsibility for the clinical administrative aspects of utilization review and case management
Integrates medical management processes with all departments within the Plan with a focus on ongoing communication
Directs Medical Management processes to be appropriate; compliant with NCQA standards and regulatory agencies and within budget
Develops and implements departmental policies and procedures as well as documentation of the case management and utilization management processes
Responsible to collaborate in the delivery of the Quality Improvement Performance Plan (QPIP) to facilitate that quality standards are met, with a focus on all assigned NCQA standards
Responsible for the selection, training of health care staff, development and implementation of policies and procedures for inpatient, outpatient and ambulatory utilization that result in delivery of medical care in a cost efficient and quality manner
Assists where necessary or through project management those business ventures undertaken by the Company to ensure its profitable future
Qualification
Required
Bachelor's Degree in Nursing, health care or business-related field
Valid RN License in state doing business in
Ten (10) years' experience in a progressively more responsible leadership role in managed care leading utilization, case and/or quality management with demonstrated experience involving clinical and quality analysis and direct interaction with health care providers with at least four (4) years' experience in a management role with direct reports, leading or assisting in all phases of effective supervisions (i.e.. recruitment, performance management, training)
Three (3) years' clinical experience in a licensed field
May require weekend supervision for staff
Preferred
Professional certification in related areas (i.e. Case Management, HEDIS)
Fifteen (15) years' experience and knowledge of Managed Care functions (e.g. medical delivery, regulatory compliance, HEDIS, NCQA)
Affiliation with a Professional Organization
Company
McLaren Health Care
McLaren Health Care is a fully integrated health network committed to quality evidence-based patient care and cost efficiency.
10001+ employees
Funding
Current Stage
Late StageTotal Funding
unknown2021-01-01Acquired
Leadership Team
Chris Candela
President and Chief Executive Officer McLaren Flint
Chad Grant
Executive Vice President & Chief Operating Officer
Recent News
2025-11-10
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