VP, Clinical Operations

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

📋 Description

• Deliver strategic and operational guidance for all clinical operations that directly engage members.

• Develop a cohesive operating framework that integrates Community Health Workers, pharmacy initiatives, care-support services, and NP-enabled offerings.

• Formulate and implement operational plans, policies, and processes to ensure safe and effective delivery of field-based, virtual, and community-oriented care.

• Collaborate with the Chief Medical Officer and Medical Director to convert clinical strategies into scalable operations.

• Provide daily leadership oversight for Nurse Practitioner workflows, capacity management, accessibility, and performance metrics.

• Work closely with Quality, Practice Performance, Care Coordination, Network, Analytics, and Technology teams.

• Enhance member engagement, care transitions, navigation, medication adherence, formulary compliance, and access for Medicaid and Medicare beneficiaries.

• Establish, monitor, and respond to indicators of quality, access, engagement, productivity, outcomes, member experience, and financial performance.

• Take responsibility for operational performance in relation to budgets and resource plans; identify discrepancies and enact corrective action plans.

• Promote HEDIS/STAR and other quality metrics with payer organizations, providers, and internal stakeholders.

• Ensure adherence to licensure, credentialing, privacy, regulatory, certification-board, payer, and company standards.

• Collaborate with Legal and Compliance on mobile and virtual care requirements and operational controls.

• Lead the implementation and optimization of clinical operations in new markets.

• Foster relationships with payer organizations, network providers, and internal stakeholders.

• Advocate for process improvements, technology integration, and effective change management.

• Recruit, mentor, develop, and retain operational leaders and team members.

• Ensure that teams are equipped with the training, tools, equipment, and resources necessary to provide high-quality care and achieve measurable results.

⛳️ Requirements

• Clinical licensure relevant to the discipline (e.g., RN, NP, PharmD, or equivalent).

• At least five (5) years of progressively responsible experience in healthcare operations, focusing on leadership of direct member-facing clinical programs or services.

• Proven experience in clinical operations supporting multidisciplinary teams and managing clinically complex Medicaid and/or Medicare populations.

• Comprehensive understanding of the regulatory and operational mandates of value-based, managed-care, field-based, mobile, virtual, or community-centered clinical programs.

• History of developing and expanding programs, managing budgets and performance metrics, and spearheading operational improvements in dynamic, high-growth settings.

• Strong analytical, problem-solving, written, verbal, and presentation capabilities, with a talent for synthesizing complex data into actionable insights and influencing diverse stakeholders.

• Ability to quickly build credibility, organize cross-functional teams, and translate strategies into practical, measurable actions.

• Proven ability to manage multiple priorities independently, handle sensitive information in compliance with HIPAA and company policies, and maintain meticulous attention to detail.

• Proficient in Microsoft Office applications and web-based technologies, including the management and analysis of large data sets.

• Preferred: Formal training in process improvement methodologies, such as Lean or Six Sigma.

• Preferred: Experience in enhancing medication adherence, pharmacy quality programs, HEDIS/STAR performance, or other quality-measure outcomes.

• Preferred: Direct experience working with payer organizations and provider networks within risk-based or managed-care frameworks.

• Preferred: Commitment to culturally competent care, health equity, and fostering positive working relationships across a diverse organization.

🏝️ Benefits

• Equal employment opportunities and protections against discrimination and harassment.

• Provision of training, tools, equipment, and resources necessary for delivering quality care and achieving measurable outcomes.

• Compensation and training included among protected employment terms and conditions (no specific benefits listed).