VP, Clinical Operations

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

📋 Description

• Develop and implement a comprehensive clinical strategy that supports medical cost management, quality performance, and member engagement objectives.

• Create end-to-end transitional care management programs for high-risk patients prior to hospitalization and facilitate transitions to suitable care settings.

• Design, execute, and enhance evidence-based protocols and interventions for chronic disease management, predictive risk stratification, and tracking of social determinants of health (SDOH).

• Lead cross-functional initiatives that integrate clinical operations, population health, risk adjustment, and quality improvement efforts.

• Assess and suggest AI-driven solutions for triage, clinical decision support, remote monitoring, and telehealth technologies.

• Collaborate with primary care providers and hospitalists to ensure effective communication and feedback.

• Oversee clinical programs from the initial concept through pilot phases, rollout, evaluation, and scaling processes.

• Establish key performance indicators (KPIs) and frameworks for measuring outcomes; monitor performance and foster continuous quality improvement.

• Integrate clinical analytics and predictive modeling to identify opportunities for intervention and evaluate return on investment (ROI).

• Ensure compliance with CMS, HEDIS, CAHPS, HOS, Stars, and risk adjustment standards.

• Partner with provider networks and care management teams to improve coordination and minimize avoidable utilization.

• Ensure uniform execution of the clinical operating model across various regions.

• Lead a large, geographically dispersed team of clinicians, managers, and support personnel.

• Cultivate leadership in operational performance management, problem-solving, and talent development.

• Set vendor expectations and metrics, monitor outcomes, and ensure vendor accountability.

• Develop standardized processes, workflows, and toolkits for delivering clinical interventions.

• Apply process improvement methodologies to optimize resource utilization.

• Promote the adoption of technology and data solutions for precise targeting, automation, and real-time insights.

• Manage responsibility for programs, productivity, cost control, revenue growth, budgets, variances, and capital expenditure planning.

• Advise executive leadership on matters related to population health, value-based care, and clinical innovation.

• Build and maintain relationships with providers, vendors, and community partners.

• Oversee recruitment, selection, orientation, training, workload assignments, performance evaluations, coaching, counseling, and performance management of staff.

⛳️ Requirements

• 5+ years of progressive leadership experience in care management, population health, or clinical operations, with a proven history of managing operations within at-risk, ACO, or capitated payer contracts.

• In-depth knowledge of Medicare Advantage regulations, Transitional Care Management (TCM), STARS and HEDIS metrics, and value-based care models.

• Proven ability to develop and implement scalable clinical programs that enhance outcomes and lower total care costs.

• Experience utilizing analytics and technology to integrate care management modules within EHR systems.

• Comprehensive understanding of utilization management, care management, and risk adjustment functions.

• Master’s degree (or higher) in Healthcare Administration, Nursing, Public Health, or a related discipline.

• Strategic thinker with robust execution capabilities.

• Excellent leadership, influence, and collaboration skills across interdisciplinary teams.

• Strong analytical mindset and comfort with interpreting clinical and financial data.

• Exceptional communication and presentation skills.

• Demonstrated commitment to innovation, member-centric care, and ongoing improvement.

🏝️ Benefits

• Competitive salary and performance-based bonuses.

• Comprehensive health, dental, and vision insurance.

• Retirement savings plan with employer matching.

• Opportunities for professional development and continuous education.

• Flexible work arrangements to support work-life balance.