Vice President, Prospective Programs

This is a fully remote position, open to applicants in Missouri.

📋 Description

• Direct the enterprise strategy for prospective risk adjustment, overseeing operations and governance across all business lines.

• Manage the performance and strategy of IHA vendors, which includes vendor selection, contract negotiations, capacity planning, outreach effectiveness, visit completions, claims submissions, invoice accuracy, service-level performance, and issue resolution.

• Spearhead the oversight and strategic direction of IOA vendors.

• Take ownership of CoC+ program strategy and implementation, encompassing program design, provider enablement, appointment agenda adoption, performance monitoring, and coordination across functions.

• Create and implement provider education and clinical documentation improvement strategies to enhance documentation quality and ensure accurate acuity documentation.

• Supervise prospective program performance across initiatives that involve providers, assessments, documentation enhancement efforts, and partnerships with vendors.

• Establish performance metrics, governance processes, and accountability frameworks.

• Collaborate with leaders in market, clinical, quality, provider engagement, finance, compliance, network, claims, and technology.

• Offer enterprise leadership and accountability across various business lines, markets, vendors, provider groups, and functional partners.

• Counsel executive leadership on prospective risk adjustment performance, opportunities, and enterprise priorities.

• Align contracts, resources, reporting, and program priorities with Procurement, Vendor Management, Finance, Claims, Compliance, Quality, local market teams, Provider Engagement, and Technology.

• Perform additional duties as assigned while adhering to all policies and standards.

⛳️ Requirements

• A Bachelor's Degree in healthcare administration, business, clinical discipline, health information management, finance, analytics, or a related field is required.

• A minimum of 10 years of progressive leadership experience in healthcare, focusing on risk adjustment, provider engagement, clinical documentation improvement, quality, or related healthcare operations is required.

• Experience in leading enterprise-level programs across various markets and business lines (Medicare, Marketplace, Medicaid) is required.

• Proven success in leading strategic initiatives, provider-facing programs, vendor collaborations, and cross-functional teams is required.

• Experience in managing vendor strategy and performance, including contract compliance, service delivery, financial reconciliation, and corrective action plans is required.

• Strong understanding of risk adjustment methodologies, healthcare operations, provider documentation, and regulatory requirements is required.

• Demonstrated executive leadership, communication, and stakeholder management skills are required.

• Equivalent experience gained through achievements that reflect the requisite knowledge, duties, scope, and skill level for this position is acceptable.

🏝️ Benefits

• Competitive pay

• Health insurance

• 401K plan

• Stock purchase plans

• Tuition reimbursement

• Paid time off plus holidays

• Flexible work arrangements, including remote, hybrid, field, or office work schedules

• Additional incentive options may be included in the overall compensation package