AVP, Utilization and Care Management Strategy

For our client, we are seeking a AVP, Utilization and Care Management Strategy to join the team of a leader in the Healthcare space. This leader will shape enterprise Medicaid utilization and care management strategy in a complex healthcare environment. The role will partner closely with operations and cross-functional teams to set performance expectations, modernize care management approaches, and improve member outcomes. This is a highly visible leadership position focused on balancing quality, affordability, clinical governance, and regulatory compliance through data-driven decision-making. Location: Remote - US based candidates only, no visa sponsorship available Compensation: $203,400 – $279,800 annually Responsibilities Lead enterprise Medicaid utilization and care management strategies. Establish strategic direction and performance expectations in partnership with operations. Oversee member-centered, data-driven Medicaid care management programs. Integrate utilization and care management strategies to enhance member outcomes. Use data to identify opportunities for care cost management and quality enhancement. Manage clinical policy governance to ensure evidence-based practices. Collaborate with cross-functional teams to modernize care management approaches. Qualifications 10+ years of leadership experience in Medicaid or managed care environments. Licensed clinician or equivalent relevant clinical credential (MD, DO, RN, NP, PA, PharmD, LCSW, etc.). Experience developing strategy and performance frameworks in complex healthcare settings. Strong knowledge of Medicaid regulations and managed care models. Demonstrated influence and leadership in a matrixed, multi-functional environment. Ability to analyze and interpret healthcare data for strategic insights. Proficiency in translating strategic priorities into actionable roadmaps. Benefits Opportunity to shape enterprise strategy and improve member care outcomes. Work in a cross-functional leadership role with diverse teams. Engagement with high-level decision-making in a complex healthcare environment. Focus on innovative solutions to enhance healthcare affordability. Contribution to improving clinical governance and regulatory compliance. Our client is an equal opportunity employer. We encourage you to apply even if you don’t meet every qualification—your background could be exactly what this team needs.