Remote Position
VP, Clinical Operations
🌍 Remote · United States
💼 Full-time
Job Description:
- Develop and execute a comprehensive clinical strategy supporting medical cost management, quality performance, and member engagement goals
- Design end-to-end transitional care management programs for high-risk patients before hospitalization and transitions to appropriate care settings
- Design, implement, and refine evidence-based protocols and interventions for chronic disease management, predictive risk stratification, and SDOH tracking
- Lead cross-functional initiatives integrating clinical operations, population health, risk adjustment, and quality improvement
- Evaluate and recommend AI-driven triage, clinical decision support, remote monitoring, and telehealth technologies
- Collaborate with primary care providers and hospitalists to ensure timely communication and feedback
- Oversee clinical programs from concept design through pilot, rollout, evaluation, and scaling
- Establish KPIs and outcomes measurement frameworks; monitor performance and continuous quality improvement
- Integrate clinical analytics and predictive modeling to identify intervention opportunities and measure ROI
- Ensure alignment with CMS, HEDIS, CAHPS, HOS, Stars, and risk adjustment requirements
- Partner with provider networks and care management teams to enhance coordination and reduce avoidable utilization
- Ensure consistent execution of the clinical operating model across regions
- Lead a large geographically distributed team of clinicians, managers, and support staff
- Develop leaders in operational performance management, problem solving, and talent development
- Establish vendor expectations and metrics, monitor outcomes, and hold vendors accountable
- Develop standardized processes, workflows, and toolkits for clinical intervention delivery
- Implement process improvement methodologies and optimize resource utilization
- Drive adoption of technology and data solutions for precision targeting, automation, and real-time insights
- Manage accountability for programs, productivity, cost control, revenue growth, budgets, variances, and capital expenditure planning
- Advise executive leadership on population health, value-based care, and clinical innovation
- Build relationships with providers, vendors, and community partners
- Oversee staff recruiting, selection, orientation, training, workload assignment, performance appraisal, coaching, counseling, and performance management
Requirements:
- 5+ years of progressive leadership experience in care management, population health, or clinical operations, with a proven track record of managing operations under at-risk, ACO, or capitated payer contracts
- Deep understanding of Medicare Advantage regulations, Transitional Care Management (TCM), STARS and HEDIS metrics, and value-based care models
- Proven track record of developing and implementing scalable clinical programs that improve outcomes and reduce total cost of care
- Experience leveraging analytics and technology and embedding care management modules inside EHR systems
- Deep understanding of utilization management, care management, and risk adjustment functions
- Master’s degree (or higher) in Healthcare Administration, Nursing, Public Health, or related field
- Strategic thinker with strong execution discipline
- Excellent leadership, influence, and collaboration skills across cross-functional teams
- Strong analytical mindset and comfort interpreting clinical and financial data
- Exceptional communication and presentation abilities
- Demonstrated commitment to innovation, member-centric care, and continuous improvement
Benefits: