About the Role
Innovaccer is seeking a Senior Director, with deep expertise in clinical operations, utilization management, prior authorization, and care coordination to lead the operationalization of AI-enabled healthcare solutions at scale.
Working within the Clinical Operations team, this leader will own the design, implementation, and continuous improvement of clinical workflows that automate administrative processes, strengthen clinical decision support, and close gaps between payer and provider operations. This is a hands-on operational role — as much about executing and refining as it is about strategizing.
The role will translate real-world nursing and utilization management experience into operational infrastructure, ensuring that Innovaccer's solutions are not only clinically sound but deployable, measurable, and sustainable across health systems and health plans.
A Day in the Life
Clinical Operations Leadership
- Own and manage day-to-day clinical operations workflows across utilization management, prior authorization, and care coordination functions
- Build and maintain operational standards, policies, and performance metrics that drive consistency and scalability across customer deployments
- Identify operational bottlenecks and lead cross-functional efforts to resolve them, working across clinical, product, and customer success teams
- Oversee workflow documentation, training materials, and change management processes to support adoption of new clinical capabilities
- Track and report on operational KPIs — including turnaround times, denial rates, and care gap closure — to inform product and program decisions
Product & Workflow Innovation
- Serve as the primary clinical operations expert for solutions addressing utilization management, prior authorization, and related workflows.
- Translate real-world nursing and utilization review workflows into scalable digital product capabilities.
- Partner with product managers to define requirements, user stories, and workflow designs.
AI & Automation Enablement
- Collaborate with data science and AI teams to identify opportunities for automation in utilization review, documentation review, and clinical decision support.
- Help design AI-enabled workflows that reduce manual administrative work for nurses and care management teams.
Clinical Validation & Usability
- Ensure product capabilities align with actual nursing workflows and regulatory expectations.
- Participate in product testing, workflow simulations, and usability validation.
Customer Insight & Implementation
- Provide subject matter expertise during product pilots and early implementations.
- Help Innovaccer understand how solutions will be used by nurses, utilization review teams, and care managers in provider and payer organizations.
Innovation Leadership
- Work closely with the Chief Innovation Officer to identify opportunities for new clinical workflow products.
- Help shape the clinical strategy for automation across administrative and clinical operations.
What You Need
- Registered Nurse (RN), BSN required; MSN or advanced clinical informatics training preferred
- 3–5 years in a clinical operations leadership role, with demonstrated experience building or managing operational functions, defining workflows, and owning performance metrics across utilization management or care management programs
- 5–10+ years of experience in utilization management, care management, or prior authorization operations
- Experience in health systems, health plans, or delegated risk organizations
- Familiarity with clinical documentation review, medical necessity criteria, and utilization review processes
- Exposure to health IT, analytics platforms, or AI-enabled healthcare solutions strongly preferred
What Makes This Role Unique
- Opportunity to directly influence the design of AI-powered healthcare workflow products
- Work at the intersection of clinical operations, analytics, and AI
- Collaborate with engineering, product, and data science teams to transform administrative healthcare workflows
We offer competitive benefits to set you up for success in and outside of work.
Here’s What We Offer
- Generous Paid Time Off: Recharge and relax with 20 days of fixed time off per year, in addition to company holidays—because we believe work-life balance fuels performance.
- Best-in-Class Parental Leave: Spend quality time with your growing family. We offer one of the industry’s most generous parental leave policies to support you during life’s most important moments.
- Recognition & Rewards: We celebrate wins—big and small. Get rewarded with monetary incentives and company-wide recognition for your impact and dedication. Your hard work won’t go unnoticed.
- Comprehensive Insurance Coverage: Stay covered with medical, dental, and vision insurance, plus 100% company-paid short- and long-term disability and basic life insurance. Optional perks include discounted legal aid and pet insurance.
Innovaccer Inc. is an equal opportunity employer. We celebrate diversity and are committed to fostering an inclusive workplace where all employees feel valued and empowered regardless of any characteristic protected by federal, state or local law including, without limitation, race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, medical condition, disability, age, marital status, or veteran status. Innovaccer Inc. participates in the E-Verify program to confirm employment eligibility of all newly hired employees based out of the U.S. and employed by Innovaccer Inc.
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