Director, Clinical Practice

The Director, Clinical Practice is a senior individual contributor accountable for shaping and advancing Sagility's clinical growth strategy across utilization management, care management, and clinical front- and back-office services for healthcare payers, providers, and workers compensation organizations. The role serves as a clinical subject-matter authority and strategic advisor across the opportunity lifecycle - from market sensing, solution design, pursuit strategy, and executive client engagement through implementation readiness, incubation, and operational handoff. The Director independently leads complex, high-value workstreams; influences cross-functional and global stakeholders without direct reporting authority; develops scalable, compliant clinical capabilities; and helps translate market needs into differentiated solutions that improve quality, experience, outcomes, productivity, and cost of care.

Key Duties and Responsibilities:

Clinical Growth and Commercial Leadership

• Own the clinical strategy and workplan for priority growth opportunities across utilization management, care management, population health, clinical review, and related front- and back-office services.
• Lead the clinical components of complex RFPs, RFIs, due-diligence discussions, solution workshops, and oral presentations; develop persuasive, evidence-based narratives, operating assumptions, and executive-level recommendations.
• Partner with sales, solutions, marketing, finance, legal, compliance, and delivery leaders to shape differentiated go-to-market propositions, campaigns, account-growth plans, and pursuit strategies.
• Engage senior client and prospect stakeholders as a trusted clinical advisor, clarifying business needs, challenging assumptions constructively, and connecting Sagility capabilities to measurable clinical and financial outcomes.
• Identify whitespace opportunities within existing accounts and emerging segments; develop business cases, value propositions, and roadmap recommendations that support sustainable revenue growth.

Clinical Solution Design and Innovation

• Architect scalable clinical operating models, workflows, governance structures, staffing approaches, quality controls, and performance frameworks aligned with client requirements and Sagility delivery capabilities.
• Translate regulatory, accreditation, market, and technology trends into practical solution requirements, including automation, analytics, interoperability, digital engagement, and AI-enabled clinical workflow opportunities.
• Define clinical requirements, guardrails, decision criteria, and success measures for new capabilities; evaluate feasibility, clinical integrity, member impact, operational risk, and return on investment.
• Create and maintain reusable solution assets, playbooks, clinical process standards, case studies, presentation materials, and intellectual property that improve consistency and speed-to-market.
• Provide expert clinical review of solution designs, statements of work, performance commitments, and transition plans to ensure assumptions are achievable, compliant, and operationally sound.

Transition, Incubation, and Operational Readiness

• Serve as the senior clinical lead for new-program transitions and expansions, establishing clinical readiness criteria across process design, workforce qualifications, curriculum, systems, documentation, quality, compliance, and reporting.
• Guide clinical talent strategies and vendor relationships, including role profiles, licensure and credential requirements, sourcing channels, competency standards, rate considerations, and quality expectations.
• Lead clinical risk and dependency reviews; identify gaps early, define mitigation plans, and escalate material concerns with clear options and recommendations.
• Incubate complex or first-of-kind clinical programs, monitor early performance, and stabilize delivery against service-level, quality, productivity, turnaround-time, and outcome commitments before structured handoff to operations.
• Develop handoff criteria, governance routines, and knowledge-transfer plans that ensure continuity, accountability, and sustained performance after transition.

Clinical Governance, Quality, and Compliance

• Embed applicable federal and state requirements, HIPAA expectations, client policies, accreditation standards, and evidence-based clinical practices into solution and operating-model design.
• Partner with quality, compliance, privacy, security, legal, and operational stakeholders to evaluate clinical risk, resolve control gaps, and support audit and client-review readiness.
• Define meaningful clinical, operational, experience, and financial measures; interpret performance data and recommend corrective or preventive actions based on root-cause analysis.
• Promote high standards of clinical documentation, decision consistency, member safety, ethical practice, and scope-of-practice adherence across proposed and incubated services.

Thought Leadership and Enterprise Influence

• Monitor competitor offerings, buyer priorities, reimbursement and regulatory developments, workforce trends, and emerging care-delivery models; convert insights into actionable recommendations for Sagility leadership.
• Author and present thought-leadership content, executive briefings, market perspectives, and client education materials that strengthen Sagility's clinical brand and credibility.
• Facilitate cross-functional decision-making across global teams, building alignment among stakeholders with competing priorities while maintaining momentum and accountability.
• Coach and mentor project teams, solution contributors, and clinical SMEs through influence and expertise; establish standards and review work products without direct people-management responsibility.
• Represent Clinical Practice in enterprise initiatives and governance forums, advocating for member-centered design, clinical quality, responsible innovation, and operational scalability.

Decision-Making Scope and Accountability

• Operates with substantial autonomy and is accountable for the quality, clinical integrity, timeliness, and executive readiness of assigned growth, solution, and transition deliverables.
• Makes recommendations that may materially influence pursuit strategy, solution scope, staffing models, implementation risk, client commitments, and investment priorities.
• Leads through influence in a matrixed environment and may direct workstreams, work products, and deliverables without having direct reports.
• Escalates decisions involving material clinical, compliance, contractual, financial, or reputational risk through the appropriate governance channels.

Qualifications and Experience

• Bachelor's degree in nursing USRN or another relevant clinical discipline required; advanced degree in nursing, healthcare administration, public health, business, or a related field preferred.
• Active, unrestricted professional clinical license, where applicable to the candidate's discipline and role requirements; nursing licensure is strongly preferred.
• Typically, 12 or more years of progressive experience in managed care, medical management, healthcare operations, clinical consulting, or related services, including significant experience in utilization management and/or care management.
• Demonstrated success leading complex clinical solution design, RFPs, executive client engagements, transitions, program launches, or transformation initiatives in a matrixed environment.
• Strong knowledge of healthcare payer and provider operations, federal and state regulatory expectations, HIPAA, and relevant accreditation and quality standards, including NCQA-related requirements.
• Experience developing business cases, performance models, operating assumptions, clinical governance structures, and measurable value propositions.
• Proficiency with Microsoft 365, data analysis and visualization, presentation development, and common UM/CM platforms or healthcare workflow technologies.
• Experience supporting global delivery, outsourced services, or business process operations is preferred.

Skills and Competencies

• Executive presence and exceptional written, verbal, facilitation, and presentation skills; able to communicate complex clinical and operational concepts clearly to diverse audiences.
• Advanced strategic thinking, structured problem-solving, data interpretation, business acumen, and sound clinical judgment.
• Ability to synthesize ambiguous inputs, establish direction, prioritize high-impact work, and deliver polished outputs under tight timelines.
• Strong stakeholder management, consultation, negotiation, conflict-resolution, and influencing skills across senior, interdisciplinary, and global teams.
• Highly self-directed, organized, adaptable, and accountable, with the ability to manage multiple complex initiatives in a high-volume environment.
• Resourceful, diplomatic, commercially aware, and committed to member-centered, ethical, compliant, and evidence-based clinical practice.