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Senior Director, Clinical Services- La Palma, CA

UnitedHealth Group

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Job Details

Senior Director, Clinical Services- La Palma, CA(Job Number:727609)

AppleCare Medical Management Group was incorporated in 2003. Over the last 17 years, the multispecialty medical group of independent practices has expanded into new communities, contracted with more hospitals and health plans, and added over 50 new doctors - but the mission has remained the same. Today, AppleCare Medical Management is comprised of hundreds of board-certified private-practice, independent physicians. Collectively, our physicians have been serving the Southeast area of Los Angeles and Northern Orange County for decades, providing their medical expertise and passion to improving the health of our communities.


The Senior Director, Clinical Services supports the Vice President of Clinical Services and the Chief Medical Officer (CMO) by overseeing the direction and management of the Clinical Services Department, providing overall leadership in process development and administration of clinical operations departmental functions.

The Sr. Director works in collaboration with the CMO, Medical Directors, and Clinical Services Directors to ensure the successful achievement of clinical metrics by participating in the development and implementation of clinical strategic initiatives to achieve the department's goals and objectives in compliance with established medical policies and procedures and health plan delegation agreements.

Primary Responsibilities:

  • Daily medical management operations and monitors the Clinical Services Department's functions in attaining defined goals and objectives that are consistent with the strategic, operational, and budgetary goals approved by the Board of Directors.  This includes all staffing and activities related to Case Management, including inpatient delegation activities and disease management

  • Functions as an operational leader who provides direction, monitoring and support for the clinical services staff

  • Identifies opportunities for improvement and provides additional orientation, training and skill development on an ongoing basis

  • Ensures all department functions are staffed appropriately and that all departmental processes are completed in a timely and accurate manner on a regular basis

  • Participates in the development of health plan / provider contracts and service standards

  • In collaboration with the managers develops, and implements and reviews the Quality Improvement and Utilization Management plans and programs annually, and revises as needed, to assure that all applicable governmental and accrediting agencies regulations are met or exceeded

  • Participates in the Clinical Services Medical Management Team and collaborates with the CMO, Medical Directors and Clinical Directors in all strategic planning, including establishing annual departmental goals and objectives by function, product development, process improvement initiatives and critical decision making

  • Under the direction of the CMO and in collaboration with the Medical Directors and Clinical Services Managers, develops and coordinates the implementation of medical management processes, policies and procedures to assure that medically necessary services are delivered in an optimally cost and quality efficient manner

  • In partnership with Medical Directors and Clinical Services Managers, identifies areas of over or under clinical utilization, often through collaboration with finance and decision support departments.  In conjunction with the CMO and the Clinical Services Medical Management Team, develops and implements corrective action plans resulting in required process changes and outcomes when aberrant trends are identified

  • Promotes a culture of open, clear communication and collaboration inter - departmentally, intra - departmentally, and with external customers and organization and drives operational excellence, employee engagement and career development

  • Leads and supports the Clinical Services Managers as needed in establishing department philosophy and objectives related to staffing and performance standards and policies and procedures, to ensure compliance with State and Federal regulatory requirements, legislative mandates, health plan delegation requirements, and accreditation standards

  • Promotes effective working relationships with health plan partners through active engagement and participation with the health plans

  • Works in conjunction with the CMO to identify and develop appropriate Joint Operations Committee (JOC) agenda items

  • Analyzes work processes and systems and identifies improvement opportunities and develops appropriate business metrics to optimize decisions, clinical outcomes and productivity

  • Works with CMO, Medical Directors and Clinical Directors to implement process and system improvements in order to achieve departmental efficiencies and resolve operational issues

  • Collaborates with key stakeholders, both inside and outside of the Clinical Services Department, to identify and make recommendations for improvements to processes and systems

  • With CMO, Medical Directors and Clinical Managers, develops and leads new program development

  • Participates in projects or committees to accomplish strategic goals and gathers data and determines resources

Job Med & Clin Ops-General Mgmt
Primary Location US-CA-LA PALMA
Other Location 
Organization AppleCare
Schedule Full-time
Number of Openings 1
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UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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