Director, Clinical Performance

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Director, Clinical Performance in United States.

This role is a senior clinical operations leadership position focused on overseeing delegated utilization management and care management activities across multiple health plan clients within Medicaid and managed care environments. You will be responsible for ensuring the consistent application of evidence-based clinical guidelines in authorization, review, and medical necessity determinations. The position plays a critical role in maintaining operational excellence, regulatory compliance, and high-quality clinical decision-making across utilization management workflows. You will lead day-to-day clinical operations while partnering closely with medical directors, compliance, and analytics teams to improve performance and identify care optimization opportunities. This is a highly hands-on leadership role combining operational oversight with direct involvement in clinical review processes. The environment is fast-paced, regulated, and mission-driven, with a strong focus on population health and care quality improvement.