Director, Clinical Services

Role Snapshot

The Director, Clinical Programs will lead all of the clinical functions across the Commercial and Medicare business lines. In this role the Director is responsible for the overall strategy, operational performance, and outcomes of WPS’s Clinical Programs. This will be accomplished through building an industry-leading suite of clinical services that advance our members’ clinical experience, specifically focusing on improving outcomes while lowering the total cost of care, and enhancing administrative efficiency and provider experience. In addition, the Director will lead the clinical and non-clinical teams, which include intake, grievance, and appeals, as well as oversee vendor partners, to successfully develop, implement, and manage the clinical services offered by WPS.

In this role you will:

• Designs and deploys innovative and industry leading clinical programs for Commercial and Medicare lines of business to include clinical support and management before, during, and after service’s are performed.
• Ensures our clinical programs position WPS to compete in the areas of Utilization and Case Management, Clinical Review, Provider Partnerships, and Ad-Hoc Clinical Initiatives or Programs for specific lines of business such as ASO.
• Develops and oversees the Clinical Programs budgets, metrics/goals and performance reporting.
• Creates organizational structure and identify and develop talent to deliver Clinical Programs metrics and goals.
• Identifies and implements tools to support the Clinical Program team and their work.
• Monitors work performance to ensure all Quality and Accreditation standards are met, while continuously designing and advancing standards, policies, and procedures.
• Ensures accuracy and timeliness of output and deliverables for assigned functional areas.
• Implements and ensures compliance with corporate management policies, practices, and procedures.

How do I know this opportunity is right for me? If you:

• Thrive on driving sustainable business growth.
• Are a visionary leader who cultivates and inspires high-performing teams through insightful mentorship and engagement strategies.
• Communicate with confidence, clarity, and sound reasoning when discussing concerns, ideas, and suggestions with all levels of staff and management.

What will I gain from this role?

• An opportunity to partner and collaborate across the organization, with Senior Management, Quality, Sales/Account Mgmt, Actuary, Product, and Operations.
• An opportunity to have a significant impact within a thriving organization.
• Experience working in an Agile environment to help drive high-priority work.
• Experience working in an environment that serves our nation’s military, veterans, Guard and Reserves, and Medicare beneficiaries.
• Working in a continuous performance feedback environment.

Minimum Qualifications

• 5 or more years of experience leading clinical functions across Commercial and Medicare business lines.
• Bachelor’s Degree in related field or equivalent post high school and/or related work experience.

• Active license as an RN in the State of Wisconsin or a valid multi-state compact license (Must maintain license after hire).

Preferred Qualifications

• Experience working in a large organization supporting multiple lines of business.

Remote Work Requirements

• High speed cable or fiber internet
• Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at https://speedtest.net)
• Please review Remote Worker FAQs for additional information

Salary Range

$150K to $165K

The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, and experience.

Work Location

We are a remote-first organization and offer remote work in the following approved states:
Arizona, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Jersey, North Carolina, North Dakota, Ohio, South Carolina, South Dakota, Texas, Virginia, Wisconsin

Benefits

• Remote and hybrid work options available
• Performance bonus and/or merit increase opportunities
• 401(k) with a 100% match for the first 3% of your salary and a 50% match for the next 2% of your salary (100% vested immediately)
• Competitive paid time off
• Health insurance, dental insurance, and telehealth services start DAY 1
• Employee Resource Groups
• Professional and Leadership Development Programs
• Review additional benefits here

Who We Are

WPS Health Solutions is a leading not-for-profit health insurer and federal government contractor headquartered in Wisconsin. WPS offers health insurance plans for individuals, families, seniors, and group health plans for small to large businesses. We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad. WPS Health Solutions has been making health care easier for the people we serve for more than 75 years. Proud to be military and veteran ready.

Culture Drives Our Success

WPS’ Culture is where the great work and innovations of our people are seen, fueled, and rewarded. We accomplish this by creating an inclusive and empowering employee experience. We recognize the benefits of Diversity, Equity, and Inclusion as an investment in our workforce—both current and future—to effectively seek, leverage, and include diverse perspectives that fuel agility and innovation on high-performing teams. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities.

We are proud of the recognition we have received from local and national organization regarding our culture and workplace: WPS Newsroom - Awards and Recognition

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Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)