VP, Care Management – Navigation

🔥 10 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🔴 Lead

👔 Vice President

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Advantmed

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2005

💼 Consulting

🛡️ Insurance

📦 Logistics

💰 Venture Round on 2016-12

Consulting • Insurance • Logistics

Advantmed is a company that specializes in providing integrated solutions to healthcare organizations, aiming to enhance the performance of health plans and providers. The company focuses on key areas such as risk adjustment, quality improvement, and health assessments, using its Elevate^ platform to deliver real-time data visibility and insights. With a commitment to market-leading accuracy, flexibility, and transparency, Advantmed partners with healthcare clients to improve outcomes, financial performance, and data accuracy. Their comprehensive services cater to both health plans and providers, enhancing member engagement, identifying care gaps, and ensuring accurate reimbursement and care delivery.

📋 Description

• Build the member intake, assessment, segmentation, care planning, navigation, referral, follow-up, and case-closure workflows for Medicare Advantage, Medicaid, and D-SNP populations. • Author playbooks, SOPs, scripts, decision trees, and clinical and non-clinical escalation protocols. • Define care coordinator and navigator staffing, caseload, and capacity models. • Hire and train the initial team. • Build training, certification, quality assurance, and performance management programs. • Establish KPIs and outcomes measurement. • Define case management and technology requirements, including build-versus-buy decisions. • Design outreach and engagement strategies to drive participation in navigation and care coordination services. • Lead the offering from concept to launch and scale staffing, processes, and technology against client volume. • Establish client reporting and unit economics from the start. • Report to the Chief Operations Officer.

🎯 Requirements

• 10+ years of healthcare operations experience, including direct ownership of care coordination, care management, member navigation, or population health programs. • Strong working knowledge of Medicare Advantage, Medicaid, and/or D-SNP populations and the health-plan operating environment they sit within. • Demonstrated experience building or significantly scaling a healthcare service operation - not solely managing an operation someone else designed. • Track record developing workflows, SOPs, staffing and capacity models, training and certification programs, quality assurance, and performance metrics from a limited or non-existent starting point. • Strong understanding of member engagement and outreach in a health-plan or care-coordination context. • Comfortable moving fluidly between strategy and hands-on execution - this role will not have a large team to delegate to at launch. • A genuine builder mindset: energized by creating something from a blank page rather than optimizing an existing operation.

🏖️ 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