Clinical Process and Standards Director (Healthcare)

Location: United States; fully remote with approximately 10% travel

Salary: $160,000–$180,000 annually, plus benefits and bonus

Company

hirify.global provides a clinical intelligence platform and agentic AI-powered solutions that streamline payer-provider decision-making, utilization management, payment accuracy, and clinical validation.

What you will do

• Lead clinical process improvement initiatives and new delegated client implementations.
• Monitor performance against client SLAs and influence operational outcomes.
• Conduct root cause analyses, develop remediation plans, and lead corrective action execution for process variation.
• Assess clinical operations processes against work instructions, policies, and procedures.
• Ensure processes meet healthcare regulatory and accreditation requirements through process mapping and work-instruction development.
• Collaborate with product and analytics teams, lead correspondence workflows, and drive cost-saving initiatives.

Requirements

• Bachelor's degree in healthcare and active clinical licensure in the state of residence; RN strongly preferred, with PT, OT, or SLP candidates with strong clinical backgrounds considered.
• 7+ years of leadership experience in healthcare operations, payer/provider communications, or utilization management.
• Experience building new functions and operational structures in ambiguous, fast-paced environments.
• Working knowledge of CMS, NCQA, and URAC regulatory and accreditation requirements.
• Strong process improvement, quality assurance, audit readiness, policy and procedure, and work-instruction development experience.
• Proficiency with Excel or Google Sheets for data analysis, presentation tools, automation technologies, letter management systems, and workflow platforms; ability to translate complex requirements into actionable technical and operational specifications.

Nice to have

• AI/ML exposure in utilization management.
• Master's degree, Lean Six Sigma certification, or inpatient utilization management experience.

Culture & Benefits

• Medical, dental, vision, life, and disability insurance, plus an Employee Assistance Program.
• 401(k) retirement plan with company match, flexible spending account, and health savings account.
• Flexible time off and company holidays.
• Up to 14 weeks of paid parental leave.
• Pet insurance and a supportive, inclusive, growth-oriented work environment.

Hiring process

• Preliminary phone screening with Talent Acquisition.
• Interview with the hiring manager.
• Behavioral interview(s).