VP, Care Management – Navigation

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

📋 Description

• Develop workflows for member intake, assessment, segmentation, care planning, navigation, referral, follow-up, and case closure for Medicare Advantage, Medicaid, and D-SNP populations.

• Create playbooks, standard operating procedures (SOPs), scripts, decision trees, and protocols for both clinical and non-clinical escalations.

• Outline staffing, caseload, and capacity models for care coordinators and navigators.

• Recruit and train the initial team.

• Establish training, certification, quality assurance, and performance management programs.

• Set key performance indicators (KPIs) and measurement of outcomes.

• Identify case management and technology needs, including decisions on building versus buying solutions.

• Develop outreach and engagement strategies to enhance participation in navigation and care coordination services.

• Oversee the offering from initial concept through launch, scaling staffing, processes, and technology in line with client volume.

• Create client reporting mechanisms and establish unit economics from the outset.

• Report directly to the Chief Operations Officer.

⛳️ Requirements

• A minimum of 10 years of experience in healthcare operations, with direct responsibility for care coordination, care management, member navigation, or population health programs.

• In-depth knowledge of Medicare Advantage, Medicaid, and/or D-SNP populations, along with an understanding of the health-plan operating environment.

• Proven experience in building or significantly expanding a healthcare service operation, rather than merely managing an existing one.

• A successful history of developing workflows, SOPs, staffing and capacity models, training and certification programs, quality assurance, and performance metrics from a limited or non-existent foundation.

• Strong grasp of member engagement and outreach in the context of health plans or care coordination.

• Ability to navigate seamlessly between strategic planning and hands-on execution, as this role will not have a large team for delegation at launch.

• A genuine builder mentality: motivated by the opportunity to create something new rather than optimizing existing operations.

🏝️ Benefits

• Health Care Plan (Medical, Dental & Vision)

• Annual Performance Bonus

• Retirement Plan (401k, IRA)

• Life Insurance (Basic, Voluntary & AD&D)

• Paid Time Off (Vacation, Sick & Public Holidays)

• Family Leave (Maternity, Paternity)

• Short Term & Long Term Disability

• Work From Home

• Wellness Resources