The Senior Director provides oversight of core medical management functions including prior authorization, utilization review, care coordination, complex case management, transitions of care, long-term services and supports, behavioral health, population health initiatives, quality assurance, provider and delegate oversight, education and training, and clinical support for Fraud, Waste, and Abuse (FWA) prevention and investigations. Oversee provider facing activities relevant to Healthcare Effectiveness Data and Information Set (HEDIS), Centers for Medicare and Medicaid Services (CMS) Stars, Covered CA performance, National Committee for Quality Assurance (NCQA), and state/federal regulatory bodies, including managing provider performance measurement and reporting.