JOB SUMMARY

Strategic and operational leader responsible for designing, implementing, and optimizing the clinical excellence shared services unit within Clinical Operations. This role ensures that cross-functional clinical and administrative processes are agile, scalable, data-driven, and aligned with the highest quality standards. The Director will lead a Multiskilled team focused on continuous improvement, project governance, data analytics, and quality assurance, serving as the critical alignment bridge between internal clinical operations, internal stakeholders and partnered medical groups.

ESSENTIAL FUNCTIONS

• Design and direct the shared services framework for clinical operations, ensuring cost-efficiency and process standardization. 
• Establish and monitor Service Level Agreements (SLAs) and key operational performance metrics (KPIs) across all clinical support areas. 
• Identify operational bottlenecks within the clinic operations and deploy process improvement methodologies (Lean, Six Sigma, Agile) to maximize productivity and regulatory compliance. 
• Provide direct leadership and professional development for a high-performance team, including: 
  Regulatory and Quality Assurance Specialists and Experts: Ensure the design of rigorous clinical and operational compliance audit and monitoring frameworks. 
• Business Intelligence and Data Analysts: Oversee the creation of data models, operational dashboards, and business intelligence to drive executive decision-making. Implement new technology and business solutions to optimize operations and/or clinical outcomes
• Strategy Execution and Support Associates: Lead projects planning and execution ensuring transformation initiatives are delivered on time, within budget, and with properly aligned executive sponsors and medical groups.
• Lead regulatory processes, policy and programs evaluations.
• Support clinical operations with the development of regulatory documents and audits readiness. 
• Work closely with Data Analytics to develop and ensure accuracy of dashboards and data analyses.
• Develop and deliver high-impact proposals, variance analyses, and performance metrics to Medical Groups and clinical committees. 
• Facilitate operational integration between the clinical operations and providers, ensuring care models and cost/quality containment initiatives are fully aligned. 
• Act as a change agent to foster a culture of operational excellence with external clinical partners and/or vendors. 
• Ensure all operational excellence initiatives comply with applicable local, state, and federal healthcare regulations. 
• Deliver executive-level progress reports, Return on Investment (ROI) analyses on improvement projects, and quality status updates to VP. 

EDUCATION

EXPERIENCE

• Bachelor’s degree in Business Administration, Industrial Engineering, Healthcare Administration, or related field. (Master’s Degree/MBA/MHA highly preferred). Minimum of 5 to 7 years of progressive leadership experience in operations, preferably within a Health Plan (Managed Care Organization - MCO) or integrated health system.
• Project Management Professional (PMP) or Agile/Scrum certification is a plus. Proven track record managing Shared Services units and leading multidisciplinary teams (QA, analysts, project managers) preferred. Direct experience preparing and delivering executive-level presentations to Medical Groups / Clinics. 
• Current/valid driver’s license for Puerto Rico. Preferred Certification: Lean Six Sigma Black Belt or Green Belt (with demonstrable experience leading projects). 

LICENSES AND CERTIFICATIONS

COMPETENCIES