Vice President, Population Health & Clinical Operations

About the Role

In partnership with the CMO, serve as a key stakeholder, decision maker, and catalyst for all market-level population health identification, strategy, evaluation, and monitoring to achieve the Quadruple Aim and drive Centene's Population Health mission at the market level.

Responsibilities

• Provide strategic leadership for population health internally, as well as with providers, community organizations, advocacy groups, and applicable legislature.
• Understand the local healthcare landscape to identify key drivers and opportunities for innovative models targeting the Quadruple Aim.
• Assess unique community health needs and attributes of the populations served to drive development of programs and services.
• Use analytics to identify key insights about the populations served and develop interventions targeting unique populations.
• Oversee performance of all Utilization Management (UM) functions (prior authorization, concurrent review) for the market per the defined partnership agreement.
• Orchestrate all elements of the population health strategy for the business.
• Drive Health Benefit Ratio (HBR) initiatives locally through strong partnership and routine collaboration with Finance.
• Partner with medical directors to translate member needs into intentional clinical program design that delivers successful health outcomes.
• Liaise with state regulators for clinical programs.
• Coordinate quality initiatives (audits, star ratings, contract reviews, etc.) and activate enterprise and local policies.
• Inform and execute against contracts (including provider contracts), driving outcomes captured in contracts and operationalizing them locally.
• Serve as a contributing member of enterprise and local committees.
• Act as an integral member of the executive leadership team, delivering clinical solutions to evolving business needs.
• Execute on standards and customize per local requirements while partnering with Centers of Excellence (COEs) to drive continuous improvement through governance and performance monitoring.
• Perform other duties as assigned.
• Comply with all policies and standards.

Requirements

• Bachelor's Degree with 5+ years of relevant experience required.
• Master's Degree preferred.
• Current state RN license preferred.

Pay

$188,900.00 - $359,800.00 per year. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives.

Benefits

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• Flexible approach to work with remote, hybrid, field, or office work schedules

Benefits may be subject to program eligibility.