Director of Clinical Services

At NTT DATA we know that with the right people on board anything is possible. The quality integrity and commitment of our employees have been key factors in our companys growth and market presence. By hiring the best people and helping them grow both professionally and personally we ensure a bright future for NTT DATA and for the people who work here.

For more than 25 yearsNTT DATA have focused on impacting the core of your business operations with industry-leading outsourcing services and automation. With our industry-specific platforms we deliver continuous value addition and innovation that will improve your business outcomes. Outsourcing is not just a method of gaining a one-time cost advantage but an effective strategy for gaining and maintaining competitive advantages when executed as part of an overall sourcing strategy.

NTT DATAcurrently seeks a Director of Clinical Services to join our team in Irvine CA.

The Director of Clinical Services leads the Clinical Services function overseeing case management disease and chronic condition management clinic services mobile health initiatives virtual health utilization wellness and population health programs and medical vendor relationships under a single accountable leader.

This role is responsible for proactively managing healthcare costs while improving member health outcomes and experience. The Director serves as the strategic and clinical leader of an integrated care model that connects case management utilization management clinical programs provider networks and health data to identify high-risk populations improve care coordination and drive measurable outcomes.

The Director collaborates with clinical advisors operational leaders data and analytics teams underwriting account management and external healthcare partners to develop and execute strategies that enhance quality of care improve member engagement and demonstrate value to employer groups and other stakeholders.

• Design and manage a comprehensive case management program for high-cost and medically complex members ensuring appropriate care in the most effective setting.
• Oversee utilization management and pre-authorization review processes as part of the overall case management strategy.
• Implement proactive outreach efforts to identify and engage high-risk members early in their healthcare journey.

• Develop and oversee programs focused on chronic conditions such as congestive heart failure (CHF) chronic obstructive pulmonary disease (COPD) diabetes and other high-impact health conditions.
• Coordinate care for members with complex or high-cost health needs to reduce avoidable hospital admissions and readmissions.
• Support medication adherence and advocacy initiatives that improve health outcomes.

• Drive utilization of clinic-based mobile health and virtual care services by connecting members to the most appropriate care setting.
• Develop reporting and visibility into utilization trends outcomes member engagement and program value.

• Lead wellness prevention and population health initiatives including biometric screening programs and chronic disease outreach.
• Design and implement member education campaigns focused on preventive care and healthy lifestyle behaviors.
• Increase engagement among underserved or disengaged populations and improve access to primary care services.

• Serve as the clinical owner of healthcare vendor relationships including care delivery organizations virtual health providers specialty clinical programs and other medical service partners.
• Establish clinical performance expectations oversee quality and member experience outcomes and ensure accountability across vendor partnerships.
• Provide clinical guidance related to provider networks healthcare access site-of-care decisions pharmacy benefits specialty medications and utilization management strategies.
• Evaluate prospective vendors and clinical programs based on quality outcomes and value while leading build-versus-buy assessments.
• Develop and facilitate ongoing performance reviews using clinical quality measures operational metrics and cost outcomes.

• Provide clinical guidance and support for healthcare service expansion initiatives including clinic and mobile health operations.
• Partner with underwriting and risk management teams to evaluate population health risks and high-cost claimants.
• Support employer group reporting and renewal discussions by translating clinical interventions engagement activities care gap closure efforts and health outcomes into meaningful business insights.
• Contribute to community health initiatives member outreach programs and health education efforts.

• Lead and develop multidisciplinary clinical teams including case managers community health workers health educators and other clinical staff.
• Establish caseload standards clinical protocols quality measures and operational best practices.
• Determine the optimal balance of internal staffing contracted services and outsourced clinical programs.
• Collaborate with physician advisors and clinical leadership to ensure medical alignment and quality oversight.

• Develop member identification models using claims data diagnosis and procedure codes pharmacy information utilization patterns and clinical program data.
• Support integration efforts across healthcare vendors data platforms and health information exchange systems.
• Define and monitor key performance indicators (KPIs) including engagement rates admissions readmissions emergency department utilization quality metrics and healthcare cost trends.
• Present outcome reports and recommendations to executive leadership and key stakeholders.

• 7 to 10 years of progressive healthcare experience including at least 5 years in leadership within a health plan managed care organization accountable care organization provider network healthcare system or integrated delivery model.
• Minimum 5 years of demonstrated success developing implementing and managing clinical programs such as case management disease management utilization management population health wellness or medical management initiatives.
• Active clinical license requiredas Nurse Practitioner (NP) or PhysicianAssistant (PA)
• Bachelors Degree or higher
• Bilingual English & Spanish required

• Bilingual Spanish proficiency.
• Proven success building and scaling clinical operations managing internal teams and external vendors and driving measurable clinical and financial outcomes.
• Experience evaluating selecting negotiating and managing outsourced healthcare vendors and clinical service providers.
• Strong understanding of healthcare claims data utilization management care coordination risk identification and performance measurement.
• Demonstrated ability to collaborate effectively with operations analytics finance underwriting account management and executive leadership teams.
• Experience working with employer-sponsored health plans self-funded health programs population health strategies or value-based care initiatives.
• Experience supporting culturally diverse and underserved populations.

• Represent the organization professionally through written verbal and visual communications.
• Travel as needed to attend meetings events training sessions or operational site visits.
• Perform additional duties projects and assignments as required.

#LI-NorthAmerica

NTT DATA provides a reasonable range of compensation for specific roles. The starting annualrange for this hybrid role is ($150000-$175000). This range reflects the minimum and maximum target compensation for the position across all US locations. Actual compensation will depend on a number of factors including the candidates actual work location relevant experience technical skills and other qualifications. This position may also be eligible for incentive compensation based on individual and/or company performance.

This position is eligible for company benefits that will depend on the nature of the role offered. Company benefits may include medical dental and vision insurance flexible spending or health savings account life and AD&D insurance short-and long-term disability coverage paid time off employee assistance participation in a 401k program with company match and additional voluntary or legally required benefits

About NTT DATA:

NTT DATA is a $30 billion trusted global innovator of business and technology services. We serve 75% of the Fortune Global 100 and are committed to helping clients innovate optimize and transform for long-term success. We invest over $3.6 billion each year in R&D to help organizations and society move confidently and sustainably into the digital future. As a Global Top Employer we have diverse experts in more than 50 countries and a robust partner ecosystem of established and start-up companies. Our services include business and technology consulting data and artificial intelligence industry solutions as well as the development implementation and management of applications infrastructure and connectivity. We are also one of the leading providers of digital and AI infrastructure in the world. NTT DATA is part of NTT Group and headquartered in Tokyo. Visit us at .

NTT DATA is an equal opportunity employer and considers all applicants without regarding to race color religion citizenship national origin ancestry age sex sexual orientation gender identity genetic information physical or mental disability veteran or marital status or any other characteristic protected by law. We are committed to creating a diverse and inclusive environment for all employees. If you need assistance or an accommodation due to a disability please inform your recruiter so that we may connect you with the appropriate team.