Sr. Director, Cinical Operations

The role

The Sr. Director will establish, scale, and manage the clinical RN review function at the Global Innovation Center in Hyderabad. This leader will build a team of US NCLEX-certified Registered Nurses to perform clinical reviews for US payer clients.

What you will do

• Lead the end-to-end setup and operationalization of the clinical RN review function at the Hyderabad GIC.
• Design and implement a scalable operating model for clinical prior authorization reviews.
• Develop and maintain Standard Operating Procedures, work instructions, and clinical review protocols.
• Establish a shift operations model to ensure overlap with US business hours.
• Recruit, hire, and onboard a team of US NCLEX-certified RNs in India.
• Implement and oversee a 6-week blended training program for newly hired RNs.
• Oversee daily execution of medical necessity reviews and clinical documentation assessments.
• Establish and maintain a clinical quality assurance framework.
• Ensure clinical operations comply with HIPAA, HITRUST, CMS, and NCQA requirements.
• Provide regular operational performance reports and clinical quality dashboards to US leadership.

Required qualifications

• Bachelor's degree in Nursing (BSN)
• Active, US Registered Nurse license (NCLEX-RN)
• Minimum 12–15 years of progressive experience in clinical operations, utilization management, and/or healthcare operations
• At least 5 years in a senior leadership role
• Knowledge and experience in utilization review / utilization management
• Proven experience setting up and managing clinical operations in a GCC/GIC/BPO/offshore environment
• Demonstrated expertise in US healthcare delivery systems, payer operations, and the prior authorization lifecycle
• Hands-on experience with clinical criteria sets including MCG Care Guidelines, InterQual, and/or equivalent evidence-based criteria
• Experience managing NCLEX-certified RN teams in India or other offshore locations
• Knowledge of clinical algorithms, care pathways, and utilization management across the care continuum
• Experience with CMS regulatory requirements, HIPAA, and HITRUST compliance frameworks
• Experience managing 50+ clinical professionals

Nice to have

• CPHQ (Certified Professional in Healthcare Quality)
• CCM (Certified Case Manager)
• CDIP (Certified Documentation Improvement Practitioner)
• Experience with AI-driven clinical intelligence platforms and healthcare technology solutions
• Prior experience at US health plans (payer-side) or managed care organizations in clinical operations leadership
• NCLEX-RN training or clinical education background
• Familiarity with delegated specialty models (MSK, cardiology, radiology, etc.)
• Proficiency with Google Workspace (G Suite), Zoom, and Mac-based environments

Before you apply

• Connect with Talent Acquisition
• Meet with the Hiring Manager
• Behavioral Interview(s)
• Case Study
• Interview with Senior Leadership

About the company

Cohere Health’s clinical intelligence platform and agentic AI-powered solutions connect health plans’ strategic goals and providers’ needs, optimizing the speed, cost, and quality of care.