Director, Ambulatory Care Operations RN

The Director, Ambulatory Care Operations RN serves as the primary clinical and operational relationship leader between the medical network and contracted Primary Care Physicians (PCPs) across the region. This role partners closely with the Regional Medical Director, outpatient providers, care management teams, and internal operational departments to improve continuity of care, strengthen provider engagement, and enhance coordination for high-risk and high-utilizing members. The Director functions as a strategic ambulatory care integrator focused on supporting PCPs with post-discharge coordination, complex patient management, outpatient follow-up compliance, and utilization awareness. This role helps bridge communication and operational gaps between inpatient settings, outpatient providers, care management teams, and health plan resources. The Director proactively engages physician offices to improve patient outcomes, reduce avoidable utilization, support value-based care initiatives, and enhance the overall provider and patient experience. The role emphasizes relationship development, operational problem solving, provider collaboration, and proactive intervention strategies designed to strengthen outpatient care coordination across the continuum of care. This position serves as a key partner to PCP offices by ensuring providers have operational visibility into high-risk patients, recent hospitalizations, emergency room utilization, care coordination opportunities, and available organizational resources to better support their attributed members. A. ESSENTIAL DUTIES & RESPONSIBILITIES PCP Engagement & Relationship Management Develop and maintain strong working relationships with contracted PCPs, office managers, nursing staff, and outpatient clinical teams. Serve as a primary operational liaison between PCP offices and Medical Management departments. Conduct routine provider outreach, engagement meetings, and operational support visits. Support PCP alignment with organizational clinical, quality, and operational initiatives. Facilitate communication between outpatient providers and internal departments regarding care coordination, operational barriers, and member needs. Promote collaborative partnerships focused on improving patient outcomes and provider satisfaction. Identify operational challenges affecting PCP offices and assist with escalation and resolution. Post-Discharge Coordination & Continuity of Care Support timely post-discharge follow-up appointments with PCP offices. Facilitate communication between inpatient teams and outpatient providers following hospitalizations. Assist PCP offices in managing recently discharged members and high-risk transitions of care. Collaborate with Transition of Care (TOC) teams to improve continuity and reduce gaps in care. Help identify and resolve barriers delaying outpatient follow-up or continuity services. Monitor transition-related workflows and support process improvement initiatives. High-Risk & High-Utilization Member Management Assist PCPs in identifying and managing high-risk, medically complex, and high-utilizing members. Provide operational visibility into: Frequent ER utilizers Frequent admissions Readmission patterns Rising-risk members Complex care coordination needs Collaborate with PCPs to support proactive intervention strategies for high-risk populations. Coordinate with Case Management, Population Health, Behavioral Health, Disease Management, and Social Services teams to support member needs. Participate in interdisciplinary case discussions and complex patient coordination efforts as appropriate. Assist in escalating complex outpatient coordination barriers affecting patient outcomes. Population Health & Utilization Collaboration Support PCP understanding of utilization trends, care gaps, and quality opportunities within their patient panels. Assist PCPs in identifying opportunities to improve utilization, care coordination, and quality outcomes within their attributed population. Collaborate with providers on initiatives aimed at reducing avoidable emergency room visits, readmissions, and unnecessary utilization. Assist with provider education related to: Transition of care best practices High-risk member management Preventive care opportunities Care coordination resources Quality improvement initiatives Partner with internal operational teams to support value-based care strategies and population health initiatives. Assist with implementation of operational workflows that improve outpatient coordination and