VP, Clinical Operations

Alignment Health•Remote Georgia, GA

11d•$227,952 - $341,928

About The Position

The Vice President of Clinical Operations is responsible for strategically developing, designing, and continuously improving clinical programs, interventions, and health initiatives for value-based care arrangements. The role focuses on holistic patient management across the continuum of care, particularly pre-hospitalization interventions and post-acute transitions, to align patient outcomes with corporate strategy, regulatory requirements, and the mission to improve member health and experience while optimizing medical cost performance. The VP oversees a large, multidisciplinary, geographically distributed organization and builds a results-driven culture. The role ensures teams deliver measurable improvements in preventing avoidable hospitalizations, eliminating gaps in care, reducing readmissions, and achieving desired member outcomes. The position also oversees assigned staff and is responsible for hiring, training, workload assignment, performance monitoring, coaching, and performance management.

Requirements

At least 5 years of progressive leadership experience in care management, population health, or clinical operations, with a record of managing operations under at-risk, ACO, or capitated payer contracts.
Deep understanding of Medicare Advantage regulations, Transitional Care Management, STAR and HEDIS metrics, and value-based care models.
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 a related field.
Strategic thinking and strong execution discipline.
Strong leadership, influence, and cross-functional collaboration skills.
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.

Nice To Haves

Active licensure as an RN, NP, PA, or MD/DO.

Responsibilities

Develop and execute clinical strategies supporting medical cost management, quality performance, and member engagement goals.
Design end-to-end transitional care management programs that engage high-risk patients before hospitalization and support safe transitions to appropriate care settings.
Design, implement, and refine evidence-based protocols and interventions for chronic disease management, predictive risk stratification, and social determinants of health tracking.
Lead cross-functional initiatives integrating clinical operations, population health, risk adjustment, and quality improvement.
Evaluate and recommend technologies such as AI-driven triage, clinical decision support, remote monitoring, and telehealth.
Collaborate with primary care providers and hospitalists to ensure timely communication and feedback.
Oversee clinical programs from concept design through piloting, rollout, evaluation, and scaling.
Establish program KPIs and outcome measurement frameworks, monitor performance, and drive continuous quality improvement.
Use clinical analytics and predictive modeling to identify intervention opportunities and measure return on investment.
Align clinical program strategies with CMS, HEDIS, CAHPS, HOS, Stars, and risk adjustment requirements, with a focus on Medicare Advantage performance.
Partner with provider networks and care management teams to improve care coordination, reduce avoidable utilization, and improve chronic disease management.
Ensure consistent execution of the clinical operating model across regions.
Lead clinicians, clinical managers, and support staff, building a culture of accountability and reliable results.
Develop leaders in operational performance management, problem solving, and talent development.
Set vendor performance expectations and metrics, monitor results, and hold vendors accountable.
Facilitate collaboration among vendors, analytics, and clinical teams to optimize program performance.
Develop standardized processes, workflows, and toolkits for clinical intervention design and delivery.
Use process improvement methodologies to streamline operations and optimize resource utilization.
Drive adoption of technology and data solutions that enable precision targeting, automation, and real-time insights.
Ensure team accountability for programs, productivity, cost control, and revenue growth, including budget development, variance correction, and capital expenditure planning.
Work with Clinical, Quality, Provider/Network, and Actuarial leaders to align clinical optimization initiatives with organizational goals.
Advise the executive team on population health management, value-based care, and clinical innovation.
Build relationships with providers, vendors, and community partners to advance clinical outcomes.
Recruit, select, orient, and train employees; assign workload; plan, monitor, and appraise job results; and coach, counsel, and manage performance.