Senior Clinical Alignment & Partnerships Leader

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

Job summary

VNS Health in New York, NY seeks a senior leader to align clinical priorities across Health Plans, Provider/Network teams, and external partners. You will govern cross-functional clinical initiatives, translate strategy into provider-facing actions, and drive quality, utilization, care management, and member outcomes.

The role partners with hospital systems, IPAs, and delegated entities to establish governance, accountability, and scalable clinical programs across the New York market, ensuring

Qualifications

• 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.
• Significant experience working at the intersection of a health plan and provider organizations and leading complex cross-functional clinical initiatives.
• Demonstrated experience engaging senior clinical and operational leaders within hospitals, health systems, physician organizations, IPAs or other provider entities.
• Strong understanding of health plan clinical priorities, including quality, utilization management, care management, population health and member outcomes.
• Demonstrated ability to establish governance, drive accountability and influence outcomes across matrixed teams without relying solely on 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 healthcare/provider market strongly preferred

Responsibilities

• Develops and leads the Health Plans approach for aligning clinical priorities with Provider/Network strategies and external provider activities.
• 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 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 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.

Education

Bachelor's Degree in Nursing/related field

Master's Degree in Healthcare Administration/related field

Job description

VNS Health in New York, NY seeks a senior leader to align clinical priorities across Health Plans, Provider/Network teams, and external partners. You will govern cross-functional clinical initiatives, translate strategy into provider-facing actions, and drive quality, utilization, care management, and member outcomes.

The role partners with hospital systems, IPAs, and delegated entities to establish governance, accountability, and scalable clinical programs across the New York market, ensuring