Director, Clinical Operations - (Middletown, RI)

Maintains operational accountability for care coordination, case management, disease management, health promotion and peer support functions to achieve the business and clinical outcomes for the health plan, meeting contract requirements. Directs all care coordination activities ensuring delivery is consistent with model of care, approved program descriptions and meets state, National Committee of Quality Assurance (NCQA) accreditation standards, Centers for Medicare and Medicaid Services (CMS), and other applicable standards and requirements. Key functions Plans, implements, directs and provides leadership and oversight of the clinical and care coordination operational processes and staff. Actively participates in cost of care and medical action plan activities. Actively participates in regulatory, quality management, performance management and accreditation activities.