NH Healthy Families · 3 days ago
Vice President, Population Health & Clinical Operations
Massachusetts, United States
Full-time
Hybrid
Mid, Senior Level
$172K/yr - $327K/yr
5+ years expCentene is transforming the health of our communities one person at a time. As the Vice President of Population Health & Clinical Operations, you will lead strategic initiatives to enhance population health and clinical operations, collaborating with various stakeholders to drive successful health outcomes.
Financial ServicesHealth CareHealth InsuranceMedical
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 look for key drivers & opportunities for innovative models targeting the Quadruple Aim
Understand the unique community health needs and the attributes of the populations served to drive development of programs and service
Uses analytics to identify key insights about the populations served and drive the development of the interventions to target unique populations
Oversees performance of all UM functions (prior authorization, concurrent review) for the market per the defined partnership agreement; co-leads agenda planning and annual performance goal setting, unique to market needs
Orchestrates all elements of the population health strategy for the business
Drives MLR initiatives locally through strong partnership and routine with Finance
Partner with the Special Investigations Unit (SIU) to proactively identify patterns of potential fraud, waste, and abuse (FWA) through clinical, claims, and utilization data insights, ensuring timely escalation and coordinated mitigation strategies. Additionally, NHHF will integrate SIU‑driven findings into Population Health & UM operational workflows, informing policy updates, provider education, and process improvements to prevent recurrence of FWA and enhance overall compliance and accountability
Partners with MDs to translate the needs of the members into intentional clinical program design that delivers successful health outcomes
Liaises with state regulators for clinical programs; proactively reviews and evaluates the utility, performance and ROI of clinical programs and acts as lead/champion to drive awareness and advocacy where needed
Develops comprehensive position papers—supported by clear rationale, data analysis, and documented recommendations—to advocate for program enhancements and strategic changes with internal and external stakeholders
Coordinates quality initiatives (audits, star ratings, contract reviews, etc.) and activate enterprise and local policies
Informs and executes against contracts (including provider contracts) – driving outcomes captured in contract and operationalizing locally
Contributing member of enterprise and local committees
Serves as an integral member of the executive leadership team, charged with delivering clinical solutions to evolving business needs
Executes on standards and customizing per local requirements while partnering with the COEs to drive continuous improvement through governance and performance monitoring
Qualification
Required
Bachelor's Degree with 5+ years of relevant experience required
Must have at least five years of progressively responsible professional experience in population health, service coordination, ambulatory care, community health, case or care management, or coordinating care across multiple settings and with multiple providers
Proven leadership in a large, matrixed organization with 3–5 years of experience working with state or federal regulators
Preferred
Master's Degree preferred
Current state RN license preferred
Benefits
Health insurance
401K
Stock purchase plans
Tuition reimbursement
Paid time off plus holidays
Flexible approach to work with remote, hybrid, field or office work schedules
Company
NH Healthy Families
NH Healthy Families is a managed care organization serving the needs of New Hampshire residents through the state Medicaid program and Ambetter Marketplace exchange product.
51-200 employees
Funding
Current Stage
Growth StageCompany data provided by crunchbase