Head of Clinical Operations

At Activate Care, we're on a mission to improve health equity and drive improved health outcomes across the country. Our Community Care Record platform, Care Link, enables healthcare and community organizations to coordinate care for populations challenged with health-related social needs (HRSN). Path Assist is our tech-enabled Community Health Worker program for addressing HRSN utilizing an evidence-based, structured intervention. Our goal is simple: address individuals' unmet HRSNs, increase health confidence, improve self-efficacy, and reduce inappropriate healthcare spend.

Activate Care is seeking an experienced operational leader to oversee the execution and performance of our clinical programs across multiple markets and contracts. The Head of Clinical Operations will ensure operational excellence, quality, and compliance across diverse program models, including social determinants of health (SDOH), and community-based care coordination initiatives.

This role bridges care model design and operational execution, translating customer requirements into reliable, high-performing programs that deliver measurable outcomes. The Head of Clinical Operations ensures all models and workflows are operationally sound, scalable, and aligned with payer expectations and member needs. The ideal candidate has deep experience managing large-scale Medicaid and Medicare Advantage operations, leading multidisciplinary teams, driving results and ROI within complex, regulated environments.

Operational Oversight & Implementation

• Provide end-to-end operational leadership for all clinical and community-based programs
• Direct the implementation of new contracts and pilots, ensuring on-time go live, staffing readiness, and adherence to SLA targets.
• Serve as the executive operational lead for customer deployments, owning staffing readiness, workflow execution, and compliance with all program deliverables.
• Coordinate across internal teams (Solutions, Strategy, Product, Data, Finance, and IT) to ensure seamless implementation and performance tracking.
• Oversee operational systems, workflows, and reporting across multiple customer platforms.
• Manage relationships with customer operational leads, resolving issues related to staffing, data exchange, documentation, or claims.

Quality & Performance Management

• Oversee Quality Improvement (QI) and Quality Assurance (QA) functions, ensuring compliance with state and customer contractual obligations.
• Establish consistent quality measurement frameworks, performance dashboards, and auditing protocols across programs.
• Drive accountability for KPIs, including reach rates, assessment completion rates, quality scores, and member satisfaction.
• Monitor and manage program performance relative to contractual Service Level Agreements (SLAs), quality withholds, and other performance-based payment terms to ensure that operational execution consistently meets or exceeds customer requirements.
• Partner with Finance and Data Team to track financial implications of SLA adherence and proactively mitigate risk of penalties or revenue loss.

Program Management & Workforce Support

• Oversee and partner closely with the Director of Clinical Operations to ensure operational readiness, standardized processes, and workforce alignment for new program launches.
• Oversee workforce planning, training, and supervision frameworks for RNs, CHWs, and other professionals.
• Create standardized tools and playbooks for onboarding, monitoring, and continuous improvement.
• 3Partner with HR to maintain staffing pipelines and address workforce performance trends.

Data, Claims, & Compliance

• Manage processes for claims submission, reconciliation, and issue resolution in collaboration with finance and Data teams.
• Ensure compliance with state and federal regulations, customer requirements, and HIPAA standards.
• Partner with customers to ensure secure data exchange and reporting to support billing and quality withhold tracking.

Cross-Functional & Strategic Collaboration

• Translate customer and market needs into actionable care model requirements, ensuring solutions are practical, scalable, and aligned with payer expectations.
• Collaborate with Strategy and Product teams to refine existing models and contribute to new care model design efforts, ensuring operational feasibility and measurable impact.
• Lead the operationalization of new care model pilots and interventions in partnership with Operations, Product, and Strategy teams.
• Work with subject matter experts to develop executable workflows, staffing plans, and performance metrics that drive operational excellence.
• Partner with Finance to develop and monitor operational budgets, PMPM cost models, and margin performance.
• Support Sales and Marketing in new business proposals by representing Activate Care's operational capabilities and implementation approach.
• Identify and advance opportunities for process automation, technology optimization, and cost efficiency across programs.

Qualifications & Skills:

• Bachelor's or Master's degree in Nursing, Public Health, or related field required (MSN preferred).
• 10-15 years of progressive leadership in Medicaid or Medicare Advantage operations.
• Proven success managing large-scale clinical operations or multi-site programs with budgets over $15M.
• Deep knowledge of Medicaid regulations, state procurement processes, SLAs, and withhold structures.
• Demonstrated experience with claims workflows, reporting, and QA/QI frameworks in multi-system documentation environments.
• Strong track record leading multidisciplinary teams (community health workers,  nurses, behavioral health, social workers).
• Excellent communication and collaboration skills across clinical, technical, and payer stakeholders.

Diversity & Inclusion:

At Activate Care, we are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates without regard to race, color, religion, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical and mental disability, marital status, sexual orientation, gender identity, gender expression, military, and veteran status, and any other characteristic protected by applicable law. Activate Care believes that diversity and inclusion among our teammates is critical to our success as a company, and we seek to recruit, develop, and retain the most talented people from a diverse candidate pool.

Activate Care does not sponsor applicants for work visas at this time.