Vice President of Clinical Operations
| Verified Pay check_circle | Provided by the employer$240,000-$275,000 per year |
|---|---|
| Hours | Full-time, Part-time |
| Location | New York, New York |
About this job
Job Description
Total Compensation: $240k-$275k
Hybrid | New York Metro Area (Candidates must reside in NY, NJ, or CT)
We are seeking a strategic and collaborative Vice President of Clinical Operations to join a mission-driven healthcare organization dedicated to improving outcomes for diverse patient populations through integrated care and value-based initiatives.
This executive leadership opportunity is ideal for a board-certified physician who has successfully combined clinical expertise with healthcare leadership. You'll play a key role in shaping medical management strategy, partnering with providers, improving quality performance, and supporting responsible utilization of healthcare resources across multiple lines of business.
Position Overview
As the Vice President of Clinical Operations, you will provide physician leadership across Utilization Management, Care Management, Population Health, and Clinical Operations. Working closely with executive leadership, you'll help drive initiatives that improve quality of care, enhance member outcomes, strengthen provider partnerships, and support organizational growth.
This position also provides oversight of physician advisors and medical directors while serving as a key clinical resource for complex operational and regulatory matters.
What You'll Do
- Provide executive leadership for Medical Management programs, including Utilization Management, Care Management, and Population Health initiatives.
- Collaborate with physician groups, healthcare providers, and risk-sharing organizations to improve clinical performance and quality outcomes.
- Lead initiatives focused on healthcare affordability, evidence-based medicine, and responsible resource utilization.
- Oversee medical necessity determinations, prior authorization reviews, provider disputes, and member appeals.
- Supervise Medical Directors and Physician Advisors while supporting professional development and clinical excellence.
- Partner with executive leadership to implement innovative care management strategies across Medicaid, Medicare, MLTC, and other managed care programs.
- Develop educational forums and physician engagement programs that promote best clinical practices.
- Serve as a clinical leader during interactions with regulatory agencies and assist with compliance-related initiatives.
- Work collaboratively with Compliance and Special Investigations teams regarding potential fraud, waste, abuse, and utilization concerns.
- Support resolution of complex member and provider issues requiring physician review.
- Analyze healthcare trends and utilization data to identify opportunities for improved quality, efficiency, and cost management.
- Represent the organization during external meetings with provider partners, healthcare stakeholders, and community organizations.
Qualifications
- Medical Degree (MD or DO) from an accredited institution.
- Active, unrestricted New York State medical license.
- Minimum of 10 years of progressive clinical and healthcare leadership experience.
- Experience within Managed Care, Health Plans, Utilization Review, Accountable Care Organizations (ACO), or Value-Based Care environments.
- Demonstrated experience supporting multiple lines of business including Medicare, Medicaid, and MLTC programs.
- Strong background in utilization management, physician engagement, quality improvement, and population health.
Why You'll Love This Opportunity
- Executive leadership role with significant organizational impact
- Hybrid work environment
- Opportunity to influence healthcare strategy and clinical innovation
- Collaborative executive team
- Mission-focused organization dedicated to improving healthcare outcomes
- Competitive executive compensation and comprehensive benefits
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