AVP, Clinical Alignment

VNS Health; New York (NY); On-site; USD 173,000 - 231,000; Full time

Job summary

VNS Health is recruiting a senior leader to drive clinical alignment across Health Plans, Provider/Network teams and external partner organizations in New York. You will translate strategy into provider-facing programs, establish governance, and manage cross-functional initiatives to improve quality, utilization and member outcomes.

This executive role requires strong stakeholder engagement with hospitals, IPAs and health systems, plus deep knowledge of Medicare/Medicaid managed care in New

Qualifications

• Minimum 10 years of progressively responsible experience in managed care, health plan clinical operations, provider performance, population health, healthcare delivery or related environment.
• Experience at the intersection of a health plan and provider organizations leading complex cross-functional clinical initiatives.
• Experience engaging senior clinical and operational leaders within hospitals, health systems, physician organizations, IPAs or provider entities.
• Strong understanding of health plan clinical priorities including quality, utilization management, care management, population health and member outcomes.
• Ability to establish governance, drive accountability and influence outcomes across matrixed teams without direct authority.
• Experience using provider and clinical performance data to identify opportunities and drive improvement.
• Knowledge of Medicare and Medicaid managed care and the New York market strongly preferred

Responsibilities

• Develops and leads the Health Plans approach for aligning clinical priorities with Provider/Network strategies and external provider activities.
• Translates clinical strategy into coordinated provider-facing initiatives across quality, utilization, care management and member outcomes.
• Establishes governance, roles, escalation pathways and accountability for shared clinical priorities.
• Builds senior relationships with clinical and operational leaders across hospitals, health systems, IPAs and other partners in New York.
• Represents clinical priorities in strategic provider discussions and partners with Provider/Network leadership on quality and outcomes.
• Serves as escalation point for complex clinical issues involving strategic provider partners and mobilizes stakeholders.
• Partners with Clinical, Quality, Analytics and Provider/Network to coordinate provider performance measures.
• Identifies trends and opportunities and works with providers to implement improvement plans.
• Monitors progress and shares best practices across the Health Plans network.

Skills

Leadership

Stakeholder engagement

Cross-functional collaboration

Education

Bachelor's degree in Nursing / Healthcare Admin / Public Health / Business Admin

Master's degree in Healthcare Admin / Public Health / Business Admin / Nursing

Job description

Overview

Provides senior Health Plans leadership for clinical alignment across VNS Health Plans' clinical organization, internal Provider/Network teams and external provider and healthcare partners. Serves as the primary integration point for cross-functional clinical work requiring coordinated action across Health Plans and provider organizations, ensuring clinical priorities are translated into aligned provider-facing strategies, accountabilities and performance expectations. Builds senior relationships with hospitals, health systems, physician organizations, IPAs, delegated entities and other strategic partners and leads collaborative efforts to improve quality, utilization, care coordination, member outcomes and provider clinical performance. The role complements, rather than replaces, the accountabilities of Clinical Operations and Provider/Network leadership by providing the governance, integration and oversight required when clinical objectives span organizational boundaries.

What You Will Do:

• Develops and leads the Health Plans approach for aligning clinical priorities with Provider/Network strategies and external provider activities and serves as the primary clinical integration point between Health Plans Clinical leadership and Provider/Network teams.
• Translates Health Plans clinical strategy into coordinated provider-facing initiatives, objectives and performance expectations across quality, utilization, care management, transitions of care, population health and member outcomes.
• Ensures provider perspectives, capabilities, barriers and opportunities inform Health Plans clinical planning and decision-making and identifies cross-functional dependencies that may impede achievement of clinical objectives.
• Establishes governance, roles, decision rights, escalation pathways and accountability mechanisms for shared clinical priorities.
• Builds and maintains senior relationships with clinical and operational leaders across key hospitals, health systems, physician groups, IPAs, delegated entities, community providers and other strategic partners in the New York market.
• Represents VNS Health Plans' clinical priorities in strategic provider discussions and partners with Provider/Network leadership when quality, utilization, clinical performance or member outcomes are material components of the relationship.
• Serves as a senior escalation point for complex clinical issues involving strategic provider partners and mobilizes internal and external stakeholders to resolve systemic barriers.
• Partners with Clinical, Quality, Analytics and Provider/Network leaders to establish a coordinated approach to provider clinical performance and meaningful measures across quality, utilization, care management and member outcomes.
• Identifies performance trends, variation and opportunities requiring intervention and works with provider organizations and internal leaders to establish improvement plans with clear objectives, owners, timelines and measures.
• Monitors progress, escalates barriers and facilitates the sharing and scaling of effective provider practices across the Health Plans network where appropriate.
• Provides leadership and oversight for complex clinical initiatives requiring coordinated execution across multiple VNS Health Plans functions and external provider organizations.
• Establishes cross-functional workstreams, governance structures, decision rights and accountabilities and brings together Clinical, Provider/Network, Quality, Operations, Product, Analytics, Pharmacy, Compliance and other stakeholders to address shared priorities.
• Facilitates resolution of issues where ownership crosses functions or organizations, makes recommendations on priorities and tradeoffs, and ensures risks and barriers are escalated to the appropriate Health Plans leaders.
• Provides senior leadership with insights on provider clinical performance, cross-functional risks, external partner issues and opportunities to improve clinical outcomes and member experience.
• Participates in special projects and performs other duties as assigned.

Qualifications

Licenses and Certifications: Clinical licensure (e.g., RN or other applicable clinical credential) preferred when relevant to the candidate's background and scope preferred

Education: Bachelor's Degree in Nursing, Healthcare Administration, Public Health, Business Administration or a related discipline required Master's Degree in Healthcare Administration, Public Health, Business Administration, Nursing or a related field preferred preferred

Work Experience:

• Minimum 10 years of progressively responsible experience in managed care, health plan clinical operations, provider performance, population health, healthcare delivery or a related healthcare environment required
• Significant experience working at the intersection of a health plan and provider organizations and leading complex cross-functional clinical initiatives required
• Demonstrated experience engaging senior clinical and operational leaders within hospitals, health systems, physician organizations, IPAs or other provider entities required
• Strong understanding of health plan clinical priorities, including quality, utilization management, care management, population health and member outcomes required
• Demonstrated ability to establish governance, drive accountability and influence outcomes across matrixed teams without relying solely on direct authority required
• Experience using provider and clinical performance data to identify opportunities and drive improvement required
• Knowledge of Medicare and Medicaid managed care and the New York healthcare/provider market strongly preferred

Pay Range

USD $172,900.00 - USD $230,500.00 /Yr.

About Us

VNS Health has been committed to meeting the needs of New Yorkers for over 130 years. We're one of the largest nonprofit home- and community-based health care organizations in the country, and today, more than 11,500 team members work together to make a difference in the lives of more than 99,000 patients and members on any given day.