Centene Corporation · 1 week ago
Vice President, Population Health & Clinical Operations
United States
Full-time
Remote
Lead/Staff, Director/Executive
$172K/yr - $327K/yr
5+ years expCentene Corporation is transforming the health of communities one person at a time, and they are seeking a Vice President to lead their Population Health and Clinical Operations. This role involves strategic leadership in population health initiatives, collaborating with various stakeholders to drive health outcomes and operational improvements.
Hospital & Health Care
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
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
Company
Centene Corporation
Centene Corporation is a leading healthcare enterprise committed to helping people live healthier lives.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Beth Johnson
President and CEO, Coordinated Care
Clyde White
President & CEO (New Hampshire Healthy Families)
Recent News
Business Journals
2024-05-06
FierceHealthcare
2024-04-28
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