Sr. Director, Cinical Operations

Opportunity Overview:

The Sr. Director, GIC India Clinical Operations is a foundational leadership role responsible for establishing, scaling, and managing the clinical RN review function within Cohere Health's Global Innovation Center (GIC) in Hyderabad, India. This leader will build a high-performing team of US NCLEX-certified Registered Nurses who perform prospective, concurrent, and retrospective clinical reviews for prior authorization cases on behalf of Cohere Health's US payer clients.

What you'll do:

• Lead the end-to-end setup and operationalization of the clinical RN review function at the Hyderabad GIC, including infrastructure, workflows, staffing models, and technology enablement via Cohere Unify
• Design and implement a scalable operating model for clinical prior authorization reviews across multiple delegated specialties
• Develop and maintain SOPs, work instructions, clinical review protocols, and decision-support frameworks aligned with US clinical standards
• 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
• Build and sustain a robust talent pipeline for NCLEX-RN professionals in the Hyderabad market
• Implement and oversee a 6-week blended training program for newly hired RNs
• Mentor and develop RN Supervisors, Team Leads, and RN Reviewers
• Oversee daily clinical review operations, including medical necessity reviews, clinical documentation assessment, guideline application, and Medical Director consultation
• Manage case volumes, workload distribution, and staffing adequacy across specialties and payer client portfolios
• Monitor and manage turnaround times for UM decisions to ensure compliance with CMS, NCQA, and client-specific standards
• Establish and maintain a clinical quality assurance framework, including inter-rater reliability assessments, audit protocols, and quality scorecards
• Ensure all clinical operations comply with HIPAA, HITRUST, CMS, NCQA, and applicable state regulations
• Serve as the primary India-based clinical operations leader, collaborating with US Medical Directors and senior leadership
• Provide operational performance reports, clinical quality dashboards, and workforce analytics to US leadership
• Serve as the escalation point for clinical operations issues originating from the India GIC

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, with at least 5 years in a senior leadership role
• Knowledge and experience in utilization review / utilization management, including prospective, concurrent, and retrospective review
• 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 MCG Care Guidelines, InterQual, and/or equivalent criteria
• Experience managing NCLEX-certified RN teams in India or other offshore locations
• Experience with CMS regulatory requirements, HIPAA, and HITRUST compliance frameworks
• Experience managing 50+ clinical professionals, including hiring, training, performance management, and workforce planning
• Strong executive presence with the ability to influence senior stakeholders

Preferred Qualifications:

• Certifications such as CPHQ, CCM, CDIP, or equivalent
• Experience with AI-driven clinical intelligence platforms and healthcare technology solutions
• Prior experience at US health plans or managed care organizations in clinical operations leadership

Working Conditions & Additional Information:

• Location: Remote in India preferably in southern states
• Work Schedule: Shift schedules for real-time collaboration with US clinical teams; flexibility for extended hours during client launches, audits, or client requirements
• Travel: Occasional travel to the United States (estimated 2 per year)
• Technology: Proficiency with Google Workspace, Zoom, and Mac-based environments preferred; working knowledge of Cohere Unify preferred (training provided)