Vice President, Clinical Operations

Job Summary:

The Vice President, Clinical Operations provides strategy, leadership and oversight to Clinical Operations, Care Coordination programs and initiatives to improve the health outcomes of the populations served and attainment of applicable quality goals of the membership. Collaborates with Market Leadership to ensure alignment of corporate and market goals with state and federal, compliance, and with the Chief Medical Officer, quality and analytics to develop and implement strategies for top tier member experience, quality results, innovations and best practice/evidenced based programs. The Vice President, Clinical Operations curates, nurtures and ensures strong relationships with community-based organizations, physical and behavioral health systems/providers to advance health equity, improve outcomes of community and membership. Develops annual goals, prepares, monitors, and analyzes variances of departmental budgets to control and appropriately allocate resources to ensure accountability for financial performance/ROI of clinical operations programs. Responsible for maintaining primary and/or supporting co-relationship with State and Federal Care Coordination offices. 

Essential Functions:

  • Provide operational and clinical expertise and strategic insights to develop a life-cycle strategy and evaluation of new programs to be prioritized or advanced into clinical operational development.
  • Establishes strategic, tactical, and financial plans to optimize the efficacy of clinical case management operations. Maintains work plans and annual goals with results reporting systems that demonstrate performance improvement trends
  • Reviews data for trends and analyzes the impact on department operations. Leads and collaborates the implementation of improved clinical care management models with utilization management to decrease readmissions and excessive length of stay and responds to regulatory changes.
  • Collaborates with utilization management and revenue cycle to ensure processes are aligned. Develops utilization targets with quality and Chief Medical Officer. Regularly provides accurate and pertinent information to appropriate leadership, departments, administration, medical staff, and others involved with CM activities
  • Responsible for the building of programmatic design, artifacts, and oversight strategies to support medical affairs, care management, quality and Utilization Management Teams
  • Develop, operationalize and oversee all standardization and clinical content to scale to growth and continued process improvements within all Clinical Operation teams
  • Responsible for updating and iterating on staffing model and approach for market variances and standardization across clinical operations with senior leaders
  • Support and plan for the communication, implementation and maintenance of clinical deliverables to meet regulatory and best practice/evidenced based protocols
  • Collaborate with the organization’s member care leaders in other key operational areas to ensure successful integration of innovation and technology are achieved to fully support clinical needs, and identify and address Social Determinants of Health
  • Provide support, leadership and direction to leaders to ensure tasks, goals and strategies are successfully achieved
  • Monitor effectiveness of Care Coordination and Clinical operational programs, annual program evaluations and ensure a continuous improvement framework.   
  • Function as a liaison/consultant/partner for clinical operations programs with regulators, market/executive level leaders, and key stakeholders
  • Serve as interim leadership for new business implementation and acquisitions to proxy for clinical leadership during the support of new market/ new/existing business as needed
  • Perform any other job duties as requested

Education and Experience:

  • Bachelor’s degree in business, healthcare or related field or equivalent years of relevant work experience is required
  • Master’s degree is preferred
  • Minimum of ten (10) years of clinical operations leadership and/or case management, disease management, medical management, quality improvement experience is required,
  • Minimum of five (5) years of senior level management experience is required
  • Minimum of five (5) years of Managed Care experience in a multi-market organization
  • Experience in a collaborative matrix environment preferred

Competencies, Knowledge and Skills:

  • Commitment to the mission and values of the CareSource Family of Companies
  • Balance of business theory, business processes, management, budgeting, and business office operations and clinical expertise  
  • Thorough understanding of care management, utilization management programs, quality and operational compliance, governance principles, analytics, business intelligence and financial acumen
  • Thorough understanding of compliance with NCQA, CMSA and regulatory standards
  • Excellent understanding of vision, operationalization, clinical data analysis and trending skills, of clinical program implementation and oversight in a market and/or multi-market delivery,
  • Proficient in Microsoft Office Suite to include Word, Excel and PowerPoint
  • Excellent oral, written, verbal communication and interpersonal skills
  • Strategic agility, operational rigor and execution with ability to develop, prioritize and accomplish goals
  • Ability to work independently and within a team environment
  • Lead a multidisciplinary team (nursing, behavioral health, social work, community health workers, etc) and any care management vendors to maximize impact to affordability, accessibility, quality, and equity.
  • Effective listening and critical thinking skills
  • Strong interpersonal skills and high level of professionalism
  • Fosters a cooperative and harmonious working culture/ climate conduce to maximize employee morale and productivity.
  • Effective problem-solving skills with attention to detail
  • Training/teaching skills
  • Population health, quality improvement, disease management, and wellness program knowledge

Licensure and Certification:

  • Case Management Certification preferred
  • CPHQ Certification preferred
  • To help protect our employees, members, and the communities we serve from acquiring communicable diseases, full COVID-19 and Influenza vaccination is an essential requirement of this position.
  • CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment. Employees hired during Influenza season will have forty-five (45) days from their hire date to complete the required vaccination.
  • CareSource requires all employees to be fully vaccinated (two weeks removed from completion of a two-dose mRNA series or two weeks removed from a one dose vaccine) against the COVID-19 virus. Employees are required to disclose and provide proof of their vaccination status as a condition of continued employment. Candidates who accept an offer of employment must upload proof of vaccination prior to their start date. Failure to meet the vaccination requirement, including providing proof of vaccination prior to the start date, may result in rescission of an employment offer or termination of employment.
  • CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be reviewed by the CareSource Health & Wellness team.

Working Conditions:

  • General office environment; may be required to sit or stand for extended periods of time