5+ years of progressive leadership experience in care management, population health, or clinical operations, with a proven track record of managing operations under at-risk, ACO, or capitated payer co
Deep understanding of Medicare Advantage regulations, Transitional Care Management (TCM), STARS and HEDIS metrics, and value-based care models.
Proven 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 related field
Strategic thinker with strong execution discipline.
Excellent leadership, influence, and collaboration skills across cross-functional teams.
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 have
Active licensure as RN, NP, PA, MD/DO
Full description
Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
The Vice President of Clinical Operations is responsible for the strategic development, design, and continuous improvement of clinical programs, interventions, and health initiatives for our value-based care (VBC) arrangements. This leader will focus heavily on the holistic management of patients across the continuum of care, specifically optimizing pre-hospitalization interventions and post-acute transitions of care to ensuring that the patient outcomes align with corporate strategy, regulatory requirements, and the organization’s mission to improve member health, enhance member experience, and optimize medical cost performance.
The VP will oversee a large, multidisciplinary organization, and will instill a results-driven culture, and ensure that teams deliver measurable improvements to prevent avoidable hospitalizations, eliminate gaps in care, reduce re-admissions, to achieve desired member outcomes.
Job Profile Summary:
The Vice President of Clinical Operations is responsible for the strategic development, design, and continuous improvement of clinical programs, interventions, and health initiatives for our value-based care (VBC) arrangements. This leader will focus heavily on the holistic management of patients across the continuum of care, specifically optimizing pre-hospitalization interventions and post-acute transitions of care to ensuring that the patient outcomes align with corporate strategy, regulatory requirements, and the organization’s mission to improve member health, enhance member experience, and optimize medical cost performance.
The VP will oversee a large, multidisciplinary organization, and will instill a results-driven culture, and ensure that teams deliver measurable improvements to prevent avoidable hospitalizations, eliminate gaps in care, reduce re-admissions, to achieve desired member outcomes.
Job Responsibilities:Strategic Leadership & Program Development
Develop and execute a comprehensive clinical strategy that supports medical cost management, quality performance (e.g., STAR ratings, HEDIS, CAHPS), and member engagement goals.
Design end-to-end transitional care management (TCM) programs that proactively engage high-risk patients before hospitalization and safely transition them to the appropriate setting.
VP, Clinical Operations at alignmenthealthcare (Remote) — aijobsearch
Design, implement, and continuously refine evidence-based clinical protocols and interventions for chronic disease management, predictive risk-stratification, and social determinants of health (SDOH) tracking.
Lead cross-functional initiatives integrating clinical operations, population health, risk adjustment, and quality improvement programs.
Evaluate and recommend emerging technologies—AI-driven triage, clinical decision support, remote monitoring, and telehealth—to improve member outcomes and program efficiency.
Collaborate effectively with primary care providers (RMOs, PCPs, SPCs) and hospitalists to ensure timely communication and feedback is received to ensure outcomes are achieved.
Clinical Program Oversight & Performance
Oversee end-to-end lifecycle of clinical programs — from concept design through pilot, rollout, evaluation, and scaling.
Establish program KPIs and outcomes measurement frameworks; monitor performance and ensure continuous quality improvement.
Integrate clinical analytics and predictive modeling to identify high-impact intervention opportunities and measure ROI.
Ensure ongoing alignment of clinical program strategies with CMS, HEDIS, CAHPS, HOS, Stars, and risk adjustment requirements with a focus on optimizing Medicare Advantage performance.
Partner with provider networks and care management teams to enhance care coordination, reduce avoidable utilization, and improve chronic disease management.
Ensure that the clinical operating model is executed consistently across regions, with minimal variation and maximum reliability.
Team Leadership & Culture
Lead a large, geographically distributed team of clinicians, clinical managers, and support staff with a clear focus on execution, accountability, and results.
Build a culture where expectations are clear; performance is monitored rigorously, and outcomes are delivered reliably.
Develop leaders who excel in operational performance management, problem solving, and talent development.
Vendor Management
Establish performance expectations and metrics for vendor partners; monitor outcomes and hold vendors accountable for results.
Facilitate cross-functional collaboration with vendors, internal analytics, and clinical teams to optimize program performance.
Operational Excellence & Continuous Improvement
Develop standardized processes, workflows, and toolkits for clinical intervention design and delivery.
Implement process improvement methodologies to streamline clinical operations and optimize resource utilization.
Drive adoption of technology and data solutions that enable precision targeting, automation, and real-time insights.
Drive accountability across the team for assigned programs, productivity, cost control, and revenue growth, including budget development, correcting budget variances, and capital expenditure planning
Collaboration & Stakeholder Engagement
Work cross-functionally with key leaders in Clinical, Quality, Provider/Network, and Actuarial to align clinical optimization initiatives with organizational goals.
Serve as a strategic advisor to the executive team on trends in population health management, value-based care, and clinical innovation.
Build strong relationships with providers, vendors, and community partners to advance shared clinical outcomes.
Supervisory Responsibilities:
Oversees assigned staff. Responsibilities include recruiting, selecting, orienting, and training employees; assigning workload; planning, monitoring, and appraising job results; and coaching, counseling, and performance management.
Job Requirements:
Experience:
Required:
5+ years of progressive leadership experience in care management, population health, or clinical operations, with a proven track record of managing operations under at-risk, ACO, or capitated payer contracts.
Deep understanding of Medicare Advantage regulations, Transitional Care Management (TCM), STARS and HEDIS metrics, and value-based care models.
Proven 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.
Education:
Required:
Master’s degree (or higher) in Healthcare Administration, Nursing, Public Health, or related field
Preferred:
Active licensure as RN, NP, PA, MD/DO
Specialized Skills:
Required:
Strategic thinker with strong execution discipline.
Excellent leadership, influence, and collaboration skills across cross-functional teams.
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.
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
Pay Range: $227,952.00 - $341,928.00Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.
*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email careers@ahcusa.com.