Regional Director of Clinical Ops & Case C at 13 Coins Holdings

Chicago, Illinois, United States -

Full Time

Start Date

Immediate

Expiry Date

12 Aug, 26

Salary

150000.0

Posted On

14 May, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Clinical Operations, Case Coordination, Value-Based Care, Quality Improvement, HEDIS, NCQA, Regulatory Compliance, Clinical Leadership, Care Management, Population Health, Performance Metrics, Strategic Planning, Interdisciplinary Collaboration, Risk Management, Healthcare Administration, Patient-Centered Care

Industry

Description

Organizational Overview Ponos Management, LLC is a mission-driven healthcare organization dedicated to improving outcomes for Medicaid populations through a physician-led, value-based care model. Our integrated approach addresses social, behavioral, physical, and economic barriers to care by delivering coordinated services designed to improve quality of life and reduce unnecessary hospital utilization. Ponos Care supports individuals living with complex and chronic conditions by providing personalized care pathways that integrate medical treatment, behavioral health services, and community-based resources. Through collaboration with interdisciplinary teams, we ensure members receive holistic and continuous care that supports long-term stability and improved health outcomes. Ponos Care continues to expand nationally, delivering innovative care management and eligibility alignment solutions that improve member outcomes and support healthcare system efficiency. Position Overview The IL-Regional Director of Clinical Operations & Case Coordination provides leadership, oversight, and strategic direction for clinical services, quality improvement initiatives, and performance outcomes across Ponos Care programs. This role ensures clinical teams operate effectively within value-based care frameworks while maintaining compliance with healthcare regulatory standards. The Director collaborates with executive leadership to strengthen care delivery models, improve quality metrics, and support continuous improvement initiatives that enhance patient outcomes and operational effectiveness. This role ensures clinical operations align with Ponos Care’s mission to deliver equitable, innovative, and high-quality care services. Core Responsibilities Clinical Program Leadership & Strategy * Provide leadership and strategic direction for clinical operations and quality improvement initiatives * Align clinical programs with value-based care objectives and organizational performance goals * Develop and implement clinical quality strategies that improve patient outcomes * Collaborate with executive leadership to support clinical program growth and scalability Quality Management & Performance Improvement * Oversee quality improvement programs aligned with HEDIS, NCQA, and value-based care standards * Monitor clinical performance metrics and implement improvement initiatives * Analyze clinical data to identify opportunities to improve care delivery outcomes * Implement corrective action plans to address performance gaps Regulatory & Compliance Oversight * Ensure compliance with federal, state, and payer regulatory requirements * Support readiness for audits and accreditation reviews * Monitor adherence to clinical documentation standards and regulatory guidelines * Partner with Compliance Officer to reduce risk exposure and maintain regulatory alignment Clinical Operations Management * Oversee clinical workflows supporting care coordination and service delivery * Ensure effective implementation of care management programs * Monitor productivity and performance outcomes across clinical teams * Identify operational improvements that enhance efficiency and quality outcomes Team Leadership & Development * Provide leadership and direction to Nurse Managers and clinical supervisors * Support professional development and performance management of clinical leaders * Promote interdisciplinary collaboration across care teams * Foster a culture of accountability, continuous improvement, and patient-centered care Collaboration & Stakeholder Engagement * Partner with executive leadership to support organizational strategic initiatives * Collaborate with data analytics teams to improve reporting and quality performance insights * Coordinate with clinical leadership to improve patient care delivery models * Engage internal and external stakeholders supporting quality improvement initiatives Program Leadership & Strategy: * Align clinical operations with Ponos Care’s value-based care delivery model * Develop strategies that improve patient outcomes and care coordination * Support implementation of scalable clinical programs * Contribute to strategic planning initiatives supporting organizational growth Regulatory & Compliance Oversight: * Ensure adherence to clinical quality standards and regulatory requirements * Maintain compliance with healthcare documentation standards * Monitor regulatory changes impacting clinical operations * Support audit readiness and regulatory reporting processes Operational Excellence & Performance Management: * Improve efficiency of clinical workflows and care coordination processes * Monitor clinical productivity and performance metrics * Identify opportunities to improve operational effectiveness * Reduce operational barriers impacting care delivery outcomes Team Leadership & Development: * Provide leadership and mentorship to Nurse Managers and clinical staff * Conduct performance evaluations and support staff development initiatives * Improve employee engagement and retention outcomes * Promote a culture of accountability and continuous improvement Innovation & Growth: * Support implementation of new clinical programs and care delivery models * Identify opportunities to improve patient care processes * Collaborate with leadership to support expansion of clinical services * Promote adoption of innovative care coordination tools and technologies QUALIFICATIONS AND EDUCATION * Bachelor’s degree in Nursing, Healthcare Administration, Public Health, or related field * Master’s degree preferred (MSN, MHA, MPH, MBA) * Active RN license preferred * 7+ years experience in clinical operations, quality management, or healthcare leadership * Experience with HEDIS, NCQA, Medicaid, or value-based care models preferred * Experience in home health, managed care, or population health environments preferred * Strong understanding of regulatory compliance and clinical performance standards EEO STATEMENT We are an Equal Opportunity Employer and are committed to fostering an inclusive and diverse workplace. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, sexual orientation, gender identity or expression), national origin, age, disability, genetic information, veteran status, or any other protected characteristic in accordance with applicable federal, state, and local laws. We believe inclusion strengthens our organization and enhances our ability to serve members and communities nationwide. We are committed to providing reasonable accommodation for qualified individuals with disabilities throughout the recruitment and employment process.

Responsibilities

The Regional Director provides strategic leadership and oversight for clinical operations, quality improvement, and case coordination within a value-based care framework. This role focuses on improving patient outcomes, ensuring regulatory compliance, and managing clinical teams to enhance operational effectiveness.