Director Clinical Operations & Compliance

Anticipated End Date: 2026-04-30 Position Title: Director Clinical Operations & Compliance Job Description: Director Clinical Operations & Compliance Hybrid 2: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The Clinical Operations & Compliance Director is responsible for the oversight and development of standard operating procedures (SOPs), standardizing practices across sites, and spearheading patient access and nursing strategy initiatives. The role ensures regulatory compliance and fosters cross-functional leadership to enhance the quality, safety, and efficiency of services. How You Will Make an Impact Primary duties may include, but are not limited to: Develop, implement, and maintain SOPs to standardize clinical practices across all sites, ensuring safe, compliant, and efficient delivery of infusion services. Collaborate with clinical leaders to ensure that documentation, workflows, and care delivery meet both internal and external standards. Manage patient access clinical review process, including prior authorization, medical necessity review, and clinical escalation workflows. Manage appeals and denials to reduce avoidable occurrences and enhance reimbursement outcomes. Support clinical strategy development and maintain the clinical competencies of nursing staff across all sites. Promote the standardization of nursing practices and adherence to evidence-based quality standards. Collaborate with the pharmacy team to maintain and optimize the drug formulary, aligning it with clinical and financial goals. Partner with trade teams to support white-glove service programs and improve patient and provider experience. Oversee all site licensure requirements, renewals, and regulatory documentation. Lead internal audits and ensure readiness for external regulatory surveys and payer audits. Collaborate with compliance teams to monitor regulatory changes and implement corrective actions as needed. Work with clinical, pharmacies, revenue cycle, finance, trade, and compliance teams to support efficient operations. Prepare reports, dashboards, and presentations for leadership, summarizing performance metrics and strategic initiatives. Drive continuous improvement efforts focused on patient access, quality, safety, and operational excellence. Hires, trains, coaches, counsels, and evaluate performance of direct reports. Moderate travel is necessary for this role (25%), will primarily involve visiting infusion clinics for audits and spot checks, ensuring SOP adherence, observation of operations, etc. Minimum Requirements: Requires a BA/BS degree in Nursing, Healthcare Administration, Business, or a related field. A minimum of 5 years of experience in clinical operations, infusion therapy, ambulatory care, patient access, or a related healthcare environment with at least 3 years of leadership or management experience; or any combination of education and experience providing an equivalent background is acceptable. A current, valid, active unrestricted RN license in the applicable state(s) or territory of the United States is required. Satisfactory completion of a Tuberculosis test is mandatory for this position. Preferred Skills, Capabilities, & Experiences: Nurse Practitioner is highly preferred. Infusion therapy and/or specialty pharmacy experience are highly preferred. Data Literacy and Fluency, ability to use data to drive decisions and improve outcomes highly preferred. Project and Program Management experience, leading initiatives and implementing improvements highly preferred. Excellent written, oral, presentation and interpersonal communication skills with the proven ability to negotiate expectations between multiple parties strongly preferred. Strong nursing contracting experience, including rate and contract language negotiation highly preferred. Proficiency of Microsoft Office products: Excel, Teams, Outlook, PowerPoint, and Word are strongly preferred. Job Level: Director Workshift: Job Family: MED > Licensed Nurse Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration. NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words — the job is posted until 3/13, not through 3/13. Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading. Join our Talent Community and stay connected with company news, information, and future job opportunities. Fueled by our bold purpose to improve the health of humanity, we are transforming from a traditional health benefits organization into a lifetime trusted health partner.  Our nearly 100,000 associates serve approximately 100M people, at every stage of health. We address a full range of needs with an integrated whole health approach, powered by industry-leading capabilities and a digital platform for health.  Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ehjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration Please visit the Contract Worker Community Page. Elevance Health is an Equal Opportunity Employer/Disability/Veterans.