Sagility · 17 hours ago
Associate Director Clinical Operations- Care Management
United States
Full-time
Remote
Lead/Staff, Director/Executive
5+ years expSagility is a company that combines technology and BPM services with healthcare expertise to enhance member experiences. The Associate Clinical Operation Director is responsible for leading Utilization Management and Case Management programs, ensuring program performance and client satisfaction.
BillingConsultingHealth CareTechnical Support
Responsibilities
Responsible for clinical and operational program performance
Client facing and primary liaison between client and Sagility
Responsible for client management and programmatic delivery
Works with an interdisciplinary care team and internal stakeholders for optimal service delivery and programmatic success
Communicates policy changes, program developments, and updates to stakeholders in a consistent and timely manner
Articulates an understanding of all policies and procedures and ensures that they are adhered to and tracked if necessary
Manages dedicated teams to include UM, CM, Accreditation, Clinical Acumen, Training and Quality
Regular and reliable attendance and timeliness
Other duties as assigned
Qualification
Required
Bachelors Degree in Nursing (RN)
A minimum of 7 years' experience as nurse in a clinical, managed care environment
Experience working with URAC and NCQA accreditation standards and survey process
Knowledgeable of State licensure and UM compliance standards
A minimum of 5 years care/case management and utilization management experience with emphasis on utilization management
Utilization Management experience with Pre-authorization, Concurrent Review, physician review and appeals processes
A minimum of 5 years management experience, managing remote team members
Understanding of Motivational Interviewing and change theory concept
Knowledgeable regarding state and federal regulations relating to Medicare and Medicaid
Ability to manage multiple projects to successful and timely completion
Demonstrated sound problem-solving analytical and decision-making skills
Knowledge of quality improvement processes
Excellent communication and presentation skills
Possesses leadership qualities of integrity, the ability to motivate others and the ability to promote harmony in the workplace
Works effectively leading a team and participating on a team
Strong member advocate: willing to go above and beyond normal responsibilities to provide the best service possible
Ability to assist member in navigating the healthcare system and community-based resources
Culturally sensitive and competent regarding membership served
Ability to work remotely
Ability to determine when to escalate issues appropriately and in a timely manner
Proficient computer skills
Preferred
master's level preferred
Certification Case Management (CCM) preferred
A minimum of 5 years' experience with government plans (Medicare, Medicaid, Marketplace) preferred
BPO experience a plus
Company
Sagility
Sagility is a technology and a transformation company that provides BPM services for healthcare centers.
10001+ employees
H1B Sponsorship
Sagility has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (6)
2023 (6)
Funding
Current Stage
Public CompanyTotal Funding
unknown2024-11-12IPO
2021-01-01Acquired
Leadership Team
Ramesh Gopalan
Group Chief Executive Officer
Recent News
Business Standard India
2025-12-11
Business Standard India
2025-11-14
Company data provided by crunchbase