VP, Clinical Operations

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $228k - $341.9k / year

⏰ Full Time

🔴 Lead

🏥 Clinical Operations

👻 Ghost score 0%

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Alignment Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2013

⚕️ Healthcare Insurance

🛡️ Insurance

🏥 Healthcare

💰 $135M Series C on 2020-03

Healthcare Insurance • Insurance • Healthcare

Alignment Health is dedicated to providing comprehensive care for Medicare members, emphasizing the needs of seniors, the chronically ill, and those who are frail. With a mission to transform senior healthcare, Alignment Health leverages a tailored care model and advanced technology to deliver high-quality, low-cost healthcare services. Their 24/7 concierge care team collaborates with trusted local providers to ensure that every member receives personalized care, reflecting the company's commitment to treating all members as valued family members.

📋 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