Director - Clinical Operations

Qlarant is a not-for-profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We have multiple lines of business including population health, utilization review, managed care organization quality review, and quality assurance for programs serving individuals with developmental disabilities. Qlarant is also a national leader in fighting fraud, waste and abuse for large organizations across the country. In addition, our Foundation provides grant opportunities to those with programs for underserved communities.

Best People, Best Solutions, Best Results

Job Summary:

Ensures the clinical integrity of the organization, products, and services with a particular focus on contract(s) in multiple jurisdictions, including federal and state. Provides administrative and clinical support to assigned project teams.

Essential Functions:

• Provides clinical information to teams.
• Provides medical review oversight which includes physician peer review activities; criteria development and assessment; correspondence regarding review determination; recruitment, credentialing and training of expert physician reviewers; managing the expert physician advisory network in specific geographic areas; and serving on external committees.
• Interfaces with external organizations including physician specialty groups, hospital  associations, medical societies, affiliates contractors, and state and federal agencies.
• Discusses specific clinical issues with attending physicians.
• Leads and/or participates in quality improvement projects as needed.
• Provides clinical input to specific projects as required by the organization or contractors.
• Supports project managers or teams with specific collaborative projects as needed.
• Maintains working knowledge of current quality improvement issues and tools.
• Manages team performance through regular, timely feedback as well as the formal performance review process to ensure delivery of exceptional services and engagement, motivation, and team development.

Level of Supervision Received:
Functions independently within broad scope of established departmental policies/practices; generally refers specific problems to manager only where clarification of departmental operating policies/procedures may be required.

Education (can be substituted for experience):
PhD required

Work Experience (can be substituted for education):
15+ years of experience required

Certification(s):
Valid, current, active, and unrestricted clinical physician license and practice as a health professional in a state or territory of the United States

Qlarant is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities.

Qlarant is a drug-free workplace. All offers of employment are contingent upon successful completion of pre-employment background and drug screens.