Vice President, Population Health – Clinical Operations
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Job Description
Centene executive leading Missouri population health strategy and clinical operations. Driving analytics, utilization management, quality initiatives, contracts, and member health outcomes.
Responsibilities:
- Serve as a key stakeholder, decision maker, and catalyst for market-level population health identification, strategy, evaluation, and monitoring
- Provide strategic leadership for population health internally and with providers, community organizations, advocacy groups, and applicable legislature
- Analyze the local healthcare landscape to identify drivers and opportunities for innovative Quadruple Aim models
- Assess community health needs and population attributes to develop programs and services
- Use analytics to identify population insights and develop targeted interventions
- Oversee all market utilization management functions, including prior authorization and concurrent review
- Orchestrate population health strategy for the business
- Drive local HBR initiatives in partnership with Finance
- Partner with physicians to translate member needs into intentional clinical program design and successful health outcomes
- Liaise with state regulators regarding clinical programs
- Coordinate quality initiatives, including audits, star ratings, and contract reviews, and activate enterprise and local policies
- Inform and execute contracts, including provider contracts, by driving outcomes and operationalizing them locally
- Contribute to enterprise and local committees
- Serve as an integral member of the executive leadership team delivering clinical solutions to evolving business needs
- Execute standards and customize them to local requirements while partnering with Centers of Excellence to drive continuous improvement through governance and performance monitoring
- Perform other duties as assigned and comply with all policies and standards
Requirements:
- Bachelor's Degree required
- 5+ years of relevant experience required
- Master's Degree preferred
- Current state RN license preferred
- Ability to lead market-level population health strategy, evaluation, and monitoring
- Experience with utilization management functions, including prior authorization and concurrent review
- Experience using analytics to identify population health insights and develop interventions
- Knowledge of healthcare markets, community health needs, clinical program design, quality initiatives, and contract operationalization
- Ability to partner with physicians, providers, Finance, regulators, community organizations, advocacy groups, committees, and executive leadership
- Ability to execute standards, customize requirements locally, and drive governance and performance monitoring
Benefits:
- Competitive pay
- Health insurance
- 401K plan
- Stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
- Flexible approach to work with remote, hybrid, field or office work schedules
- Additional forms of incentives may be included in total compensation
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