Director, Software Development (Managed Care)

Director, Software Development (Managed Care) Dallas-Fort Worth, TX Job Details $130,000•$190,000 a year 13 hours ago Qualifications Project reporting Application Integration Strategic management Data Integration (Data management) EDI Medicare HIPAA compliance management Workflow management (operations management method) New product development Project planning Word processing Healthcare Administration Regulatory compliance Compliance audits & assessments HIPAA Data reporting Visio English Application deployment Enterprise architecture State healthcare regulations Quality assurance within IT 3 years Master's degree Application development Change management Client services experience within consulting industry Team development Hiring Technical solutions implementation Key Performance Indicators Policy & process development Proposal writing Bachelor's degree IT experience within healthcare Project monitoring Utilization management NCQA standards Staff training Quality improvement Centers for Medicare and Medicaid Services (CMS) Data analytics Healthcare team management Bachelor's degree in healthcare administration Overseeing audit functions CRM system proficiency Productivity software Lean management Senior level Cross-functional collaboration Account management Project leadership Leadership Implementing cost-saving initiatives Team motivation (leadership skill) Communication skills Cross-functional communication Consulting firm experience Senior leadership Staff development Performance evaluation

Full Job Description Company Description:

Clearlink Partners is an industry-leading managed care consultancy specializing in end-to-end clinical and operational management services and market expansion initiatives for Managed Medicaid, Medicare Advantage, Special Needs Plans, complex care populations, and risk-adjusted entities. We support organizations as they navigate a dynamic healthcare ecosystem by helping them manage risk, optimize healthcare spend, improve member experience, accelerate quality outcomes, and promote health equity.

Position Responsibilities:

Specific Lead the development, integration, and deployment of new applications, system software, and enhancements across the Health Plan enterprise. Direct and maintain core health plan systems, including claims adjudication, EDI/X12, CRM, data warehouses, and analytics/reporting platforms. Oversee data integration and interoperability among health plan systems, providers, and external partners (EDI, APIs, HIEs). Partner with IT leadership to ensure alignment with enterprise architecture standards and goals. Drive the use of technology to solve complex business challenges, from aligning with company strategy to defining requirements and delivering successful solutions. Provide leadership and direction to the team to support ongoing business operations. Coordinate with Infrastructure Services to address system and environment requirements. Evaluate existing applications for performance and efficiency, and implement improvements to enhance processes and decision-making. Ensure all new software integrations meet functional requirements, compliance standards, and interface specifications. Establish, promote, and enforce policies, procedures, and quality assurance best practices. Oversee talent management, including hiring, coaching, development, performance evaluations, and corrective actions; conduct regular one-on-ones and provide continuous feedback. Foster collaboration with key departments to align and coordinate business activities. Lead process improvement initiatives across departments using Lean methodologies, visual management tools, and daily huddles to track KPIs and drive continuous improvement. Contribute as an active participant in Manager/Supervisor meetings. Engage in strategic and internal committees to share insights and represent organizational values and direction. Provide IT leadership across health plan operations, including claims, enrollment, eligibility, provider data, utilization management, and population health systems. Provide IT leadership for health plan operations, including claims, enrollment, eligibility, provider data, utilization management, and population health platforms General Provide direction for health plan market/ product level operational oversight, management and performance improvement Leverage industry expertise and expert knowledge, grounded in research and industry best practice, to provide high value consulting and advisory services Deliver innovative, integrated solutions in support of client goals and engagements. Provide delivery assurance support for engagements with assigned clients Support or lead engagements ensuring completion of contracted services create and/ or manage to project plans write proposals/reports present to Client executives facilitate, advise and persuade key decision makers and influencers Deliver concise, clear interpersonal communication to both internal and external audiences Facilitate streamlined exchange of information with all levels of Clearlink and client organization(s) Articulate performance across multiple projects with qualitative and quantitative results/ outcomes Influence others to understand and accept strategies, goals and plans in response to changing business conditions Develop methodologies and best practices to be applied across individual account strategies/ client plans. Establish goals and track progress to ensure achievement Act in interim leadership capacity to provide supervision and oversight for teams and activities in a direct supervisory model Identify opportunities to improve workflow, generate accurate, high quality productivity, support organizational compliance with requirements and deliver reductions in associated costs with improvement in organizational quality performance in collaboration with Client leaders Develop or update policies and procedures as required to support business needs and requirements Identify opportunities to streamline and/ or automate workflows for accurate, high quality production and improved results in cost savings, or outcomes measurement. Coach and motivate staff to reach established engagement goals, deliverables and KPIs Adapt processes, approach, plan and/ or activities in real time when targets, goals or timelines are at risk to ensure critical path activities are achieved Support account management relationships with key client decision makers Develop and deploy management reporting, if indicated, to support monitoring and improvement of performance, implementing plans for improvement as necessary Responsible for the engagement quality, maintaining appropriate resources, competency training and education of staff Responsible for approving and managing day to day engagement resourcing/ time and attendance as an Engagement Manager Oversee compliance with internal client related audits, support Client preparation for external audits and surveys

Position Qualifications:

Competencies:

Proficiency managing complex work in challenging environments through the alignment of resources and prioritization of efforts to ensure on time, in scope project and/ or strategic delivery. Managed care industry expertise in trends, innovation, operations, financing, costs, requirements, performance and outcomes New product/ market design and implementation in the Commercial, Medicare, Medicare Advantage, Medicaid or associated lines of business New population identification, program design and implementation to support needs/ requirements of increasingly complex memberships while ensuring stable operations and target outcomes Strong understanding of legal and regulatory frameworks, healthcare administration models, and internal audit procedures. Work closely with concepts such as HIPAA, as well as State's Department of Insurance, Federal and State Health and Human Services, CMS, NCQA, and URAC, to ensure compliance with complex regulatory structures. Strategic thinker with ability to produce and manage system-wide change through influence and persuasion Knowledge of project management principles, methods, and techniques Ability to organize, prioritize, and manage multiple complex projects Excellent communication skills both written and oral High proficiency with core office software (Excel, Word, and PowerPoint). Visio skills preferred

Experience:

Bachelor's Degree in Healthcare Administration or related field, Master's degree preferred 5+ years progressive leadership experience in health plan operations, delivering results and managing teams and projects in a health plan setting and/or consulting environment; driving complex, multi-faceted, multi-site, application/operational change/improvement programs and activities. 3+ years of management experience in a government payor environment at a Director or equivalent level with experience in multiple lines of business (Medicare, Medicaid, Healthcare Exchange, etc)

Physical Requirements:

Must be able to sit in a chair for extended periods of time Must be able to speak so that you are able to accurately express ideas by means of the spoken word Must be able to hear, understand, and/or distinguish speech and/or other sounds in person, via telephone/cellular phone, and/or electronic devices Must have ample dexterity which allows entering of text and/or data into a computer or other electronic device by means of a keyboard and/or mouse Must be able to clearly use sight so that you are able to detect, determine, perceive, identify, recognize, judge, observe, inspect, estimate, and/or assess data or other information types Must be able to fluently communicate both verbally and in writing using the English language Must be able to engage in continuous social interaction, successfully manage stressful high conflict situations, and balance multiple duties, expectations and responsibilities simultaneously

Time Zone:

Central; Must reside in

Dallas-Forth Worth, Texas Other Information:

Expected Hours of Work:

Monday•Friday 8a.m.•5 p.m.; with ability to adjust to Client schedules as needed

Travel:

May be required, as needed by

Client Direct Reports:

None Salary Range:

$130,000•$190,000

EEO Statement:

? It is Clearlink Partners' policy to provide equal employment opportunity to all employees and applicants without regard to race, sex, sexual orientation, color, creed, religion, national origin, age, disability, marital status, parental status, family medical history or genetic information, political affiliation, military service or any other non-merit-based factor in accordance with all applicable laws, directives and regulations of Federal, state and city entities. This salary range reflects the minimum and maximum target wage for new hires of this position across all US locations. Individual pay will be influenced by Experience, Education, Specialized Soft Skills, and/or Geographic location.