Remote Clinical Program and Population Health Strategist-Government Programs
About The Position
The Clinical Program and Population Health Strategist – Government Programs advances population health strategy for ACA, Medicaid, and Dual Eligible Special Needs Plan (D-SNP) populations. The role aligns with Presbyterian’s integrated delivery system model and Health Value strategy, partnering across the health plan, medical group, and care delivery system. The Strategist translates enterprise population health priorities into product-specific strategies, clinical program designs, and a prioritized Clinical Initiative Portfolio. The role influences execution through cross-functional partnerships but does not directly manage program operations or vendor performance. It reports to the Vice President, Population Health, Provider Strategy and Performance, and collaborates across Presbyterian Health Plan and Medical Group. Strategies and program designs address regulatory requirements, quality and utilization goals, health equity, and community integration. Key performance areas include Medicare Stars and HEDIS performance, Medicaid quality measures, gap closure and preventive care utilization, total cost of care and utilization trends, Clinical Initiative Portfolio performance and ROI, and health equity outcomes.
Requirements
- Bachelor’s degree required.
- 5–10+ years of experience in population health, healthcare strategy, or clinical program design.
- Experience with Medicare (D-SNP) and/or Medicaid programs.
- Strong understanding of HEDIS, Stars, risk adjustment, and utilization drivers.
- Experience working in a matrixed organization.
- Strategic thinking and portfolio prioritization.
- Clinical program design and innovation.
- Data-driven decision making.
- Cross-functional collaboration and influence.
- Strong communication and executive presence.
- Health equity focus.
Nice To Haves
- Master’s degree (MPH, MHA, MBA, or related) preferred.
Responsibilities
- Develop population health strategies for ACA, Medicaid, and D-SNP populations aligned with enterprise priorities.
- Identify high-impact opportunities to improve outcomes for complex and vulnerable populations.
- Ensure strategies align with regulatory requirements and product-specific goals.
- Support development and refinement of the Clinical Initiative Portfolio.
- Partner with product owners and leadership to prioritize initiatives based on impact and ROI.
- Define success metrics aligned with HEDIS, Stars, risk adjustment, and utilization goals.
- Design evidence-based clinical programs and interventions, defining target populations, program goals, and success measures.
- Partner with program and operational leaders to support implementation and scaling.
- Inform build-versus-buy decisions for clinical capabilities.
- Translate clinical strategies into provider-facing approaches and support development of provider tools, workflows, and reporting.
- Provide input into value-based care models and provider performance strategies.
- Serve as a liaison to Government Programs teams and align benefit design, clinical programs, and population health outcomes.
- Collaborate with analytics, network, and operations teams.
- Partner with analytics teams to define measurement frameworks; use data to identify trends, gaps, and opportunities and translate insights into recommendations.
- Ensure strategies align with CMS and Medicaid requirements; support audits, reporting, and program integrity efforts.
- Embed health equity in strategies and program designs, identify disparities, recommend targeted interventions, and partner with community organizations and internal teams.
Benefits
- Medical insurance
- Dental insurance
- Vision insurance
- Short-term disability insurance
- Long-term disability insurance
- Group term life insurance
- Optional voluntary benefits
- Employee Wellness rewards program with opportunities to earn gift cards through wellness activities
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What This Job Offers
Job Type
Full-time
Career Level
Senior
