Program Manager - Clinical Operations (Healthcare)

Location: Remote, United States

Company

hirify.global provides technology-enabled business process management and healthcare services focused on clinical operations, member engagement, claims, provider solutions, payment integrity, and analytics.

What you will do

• Lead end-to-end clinical operations programs, including planning, implementation, monitoring, governance, and optimization.
• Manage workstreams covering care management, utilization management, transitions of care, chronic disease management, population health, and value-based care.
• Improve workflows and outcomes by reducing avoidable admissions, readmissions, emergency department utilization, and total cost of care.
• Coordinate clinical, operational, technology, quality, analytics, payer, provider, and client stakeholders.
• Develop KPIs, dashboards, scorecards, executive reporting, and data-driven improvement recommendations.
• Manage program risks, operational changes, audit readiness, regulatory compliance, and corrective action plans.

Requirements

• Bachelor’s degree in healthcare administration, nursing, public health, life sciences, business administration, or a related field.
• 7+ years of experience in healthcare operations, care management, utilization management, population health, or clinical program management.
• 3+ years of experience leading cross-functional programs or large-scale operational initiatives.
• Strong understanding of healthcare payer and provider operations and experience with clinical and operational performance metrics.
• Knowledge of NCQA, CMS, HIPAA, URAC, and client-specific requirements.

Nice to have

• Master’s degree such as MBA, MHA, MPH, or MSN.
• PMP, Lean Six Sigma, or healthcare quality certification.
• Experience with value-based care, risk adjustment, population health management, HEDIS, STAR Ratings, or care management programs.
• Familiarity with EMR/EHR systems, care management platforms, and healthcare analytics tools.

Culture & Benefits

• Work-from-home position supporting healthcare programs.
• Collaboration with clinical leaders, physicians, nurses, care managers, operations, analytics, and client stakeholders.
• Focus on member outcomes, operational efficiency, quality improvement, and regulatory compliance.
• Equal opportunity employer with veteran and disability inclusion.