AVP, Clinical Process Improvement

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

Job summary

VNS Health seeks a strategic leader to design, standardize and continuously improve clinical processes across health plans. You will guide cross-functional teams through assessment, redesign, implementation and measurement to enhance clinical quality, regulatory compliance and financial stewardship.

You will partner with Clinical leadership, Operations, Quality and Technology to translate requirements into sustainable operating processes and drive initiatives across Utilization Management, Care

Qualifications

• Active clinical licensure; RN preferred depending on background
• Bachelor's Degree in Nursing, Healthcare Administration, Public Health or related field required
• Master's Degree preferred in Healthcare Administration, Nursing or related field

Responsibilities

• Lead clinical process improvement strategy, standards and governance across plans
• Partner with clinical and executive leadership to identify and prioritize opportunities
• Define ownership, controls, and performance expectations across products and populations
• Lead end-to-end redesign of complex clinical workflows and improve outcomes and efficiency
• Define future-state processes, workflows and documentation standards
• Oversee implementation readiness, staffing, training and change management
• Translate operating requirements into technology-enabled workflows and automated solutions
• Monitor performance, investigate issues and implement corrective actions
• Report on portfolio outcomes including clinical, quality and financial metrics
• Ensure CMS and NYS requirements are integrated into process design and audits readiness

Skills

Clinical process improvement

Cross-functional leadership

Healthcare operations

Education

Bachelor's Degree in Nursing

Master's Degree in Healthcare Administration/related field

Tools

Lean Six Sigma certification

Job description

Overview

Provides strategic leadership for the design, standardization, documentation, implementation and continuous improvement of clinical processes across VNS Health Plans. Establishes the approach and operating discipline through which health plan clinical workflows are assessed, redesigned, implemented, measured and improved, with a focus on clinical quality, regulatory compliance, operational performance, member/provider experience and financial stewardship. Leads complex cross-functional improvement efforts across areas such as Utilization Management, Care Management, Population Health, clinical programs, quality-related clinical workflows and appeals, partnering with Clinical leadership and functions including Operations, Quality, Compliance, Technology, Product and Analytics to translate strategy and requirements into sustainable clinical operating processes.

What You Will Do

• Establishes and leads the clinical process improvement strategy, standards and governance framework for VNS Health Plans, including methodologies for process assessment, design, documentation, implementation, measurement and continuous improvement.
• Partners with Health Plans Clinical and executive leadership to identify, prioritize and sequence high-impact clinical process improvement opportunities based on member impact, clinical and quality outcomes, regulatory risk, operational performance and business value.
• Establishes clear process ownership, decision rights, controls, accountabilities and performance expectations while appropriately addressing differences across products, populations and regulatory requirements.
• Leads end-to-end assessment and redesign of complex health plan clinical workflows; identifies variation, duplication, bottlenecks, handoff failures, administrative burden, compliance risk and opportunities to improve outcomes and efficiency.
• Defines future-state processes, workflows, business rules, roles, responsibilities, handoffs, controls and escalation pathways and establishes standards for clinical process documentation and version management.
• Leads implementation and operational readiness for redesigned clinical processes, including workflow, technology, staffing, training, communications, controls, measurement, change impacts and post-implementation stabilization.
• Partners with Technology and clinical leaders to translate operating requirements into technology-enabled workflows and identifies appropriate opportunities for automation, decision support and emerging technologies.
• Establishes mechanisms to monitor clinical process performance, identify variation and emerging issues, conduct root-cause analysis and implement sustainable corrective solutions.
• Defines measures and executive reporting for the clinical process improvement portfolio and quantifies operational, clinical, quality, member/provider experience and financial outcomes of improvement initiatives.
• Integrates CMS, New York State, accreditation and other applicable requirements into process design and partners with Compliance, Quality and Legal to mitigate operational and regulatory risk and support audit/readiness activities.
• Builds continuous-improvement capability across Health Plans clinical functions through repeatable methodologies, tools, coaching and knowledge transfer.
• Serves as a trusted advisor to Health Plans clinical leadership on process design, operating-model improvement and clinical transformation and presents recommendations, business cases, risks and outcomes to senior leadership.
• Leads complex cross-functional initiatives spanning Clinical, Operations, Quality, Compliance, Product, Technology, Analytics, Finance and other functions; creates alignment on future-state processes, accountabilities and implementation requirements.
• Develops change and adoption strategies for significant process changes and partners with operational leaders and Learning & Development to ensure new practices are understood, adopted and sustained.
• Provides leadership to assigned process-improvement resources and/or project teams, establishing priorities, standards and performance expectations; builds broader process-improvement capability within clinical teams.
• Participates in special projects and performs other duties as assigned.

Qualifications

Licenses and Certifications

Active clinical licensure, such as Registered Nurse (RN), preferred when relevant to the candidate's background and scope

Lean/Six Sigma or comparable process-improvement certification preferred; project or change-management certification preferred

Education

Bachelor's Degree in Nursing, Healthcare Administration, Business Administration, Public Health, Industrial/Systems Engineering or a related discipline required

Master's Degree in Healthcare Administration, Business Administration, Public Health, Nursing or a related field preferred

Work Experience

• Minimum 10 years of progressively responsible experience in healthcare, managed care, clinical operations, healthcare consulting, operational excellence or a related environment required
• Significant experience leading complex clinical process improvement, clinical transformation or operational-excellence initiatives in a health plan or managed-care environment required
• Demonstrated experience redesigning clinical processes across functions such as Utilization Management, Care Management, Population Health, Quality, clinical programs or related health plan operations required
• Demonstrated experience leading initiatives from current-state assessment and future-state design through implementation, adoption and measurement required
• Experience translating clinical and regulatory requirements into technology-enabled workflows and operating processes required
• Experience leading significant change and influencing leaders and teams across a complex, matrixed organization required
• Knowledge of Medicare, Medicaid, CMS and New York State managed-care requirements 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.