VP, Care Management & Navigation

Advantmed; Irvine (CA); Hybrid; USD 180,000 - 260,000; Full time

Benefits offered by this job

Health insurance

Annual bonus

401k

Life Insurance

Paid Time Off

Family leave

Disability insurance

Work From Home

Wellness resources

Job summary

Advantmed is building a new Care Coordination and Benefits Navigation offering and seeks an experienced healthcare operator to lead the venture from the ground up. This builder role covers designing the operating model, creating playbooks, and standing up the technology and staffing infrastructure.

You will hire and train the initial team, drive launch through execution, and align processes with Medicare Advantage, Medicaid, and D-SNP populations, while establishing KPIs, reporting, and scalable

Qualifications

• 10+ years in healthcare operations with care coordination or population health programs.
• Strong knowledge of Medicare Advantage, Medicaid, and/or D-SNP populations.
• Experience building or scaling a healthcare service operation from scratch.
• Proven ability to develop workflows, SOPs, staffing models, and performance metrics.
• Strong understanding of member engagement in health plan contexts.
• Able to work across strategy and hands-on execution with limited delegation.
• Builder mindset: enjoys creating new operations from a blank page.

Responsibilities

• Design the end-to-end operating model. Build member intake, assessment, segmentation, care planning, navigation, referral, follow-up, and case-closure workflows from a blank page, scoped to Medicare Advantage, Medicaid, and D-SNP populations.
• Build the operating infrastructure. Author the playbooks, SOPs, scripts, decision trees, and clinical and non-clinical escalation protocols the team will run on.
• Stand up staffing and capacity. Define care coordinator and navigator staffing, caseload, and capacity models, and hire and train the initial team against them.
• Establish performance infrastructure from day one. Build training, certification, quality assurance, and performance management programs, along with the KPIs and outcomes measurement the business will be run on.
• Define the technology footprint. Set the case management and technology requirements needed to run the operation, including any build-versus-buy decisions.
• Own member engagement. Design the outreach and engagement strategies that drive participation in navigation and care coordination services.
• Take the offering to launch and scale. Sequence the build so the business moves from concept to live operation, then scales staffing, process, and technology against real client volume — with client reporting and unit economics in place from the start.

Skills

Healthcare operations

Care coordination

Population health

Workflow design

Staffing & capacity planning

Quality assurance

Performance metrics

Member engagement

Strategy to execution

Builder mindset

Job description

About Advantmed

Advantmed is a healthcare services company headquartered in Irvine, California, serving primarily health plans that participate in government-sponsored programs. The Company operates three lines of business: medical record retrieval; medical record review and coding; and in-home health assessments. Together these support health plans across risk adjustment, HEDIS, quality reporting, and member care — with a substantial delivery organization in Ahmedabad, India supporting the U.S. operation.

In-home health assessments are the Company’s newest line of business and its fastest growing. Launched in 2017 and scaled significantly from 2024, the business today deploys a network of approximately 500 nurse practitioners and clinicians across roughly 32 states on behalf of 10 to 12 health-plan clients. Members are engaged through a combination of outbound telephony, text, direct mail, and a self-scheduling portal, and are seen in their homes by a clinician who completes a comprehensive assessment on the plan’s behalf.

In-home health assessment is where Advantmed sees its largest opportunity, and the Company has invested accordingly. Recent additions to the leadership team include a Chief Revenue Officer and a Senior Vice President of Client Success, both having previously served at Signify Health, and a Senior Vice President of Product Management with prior health-plan experience at SCAN. The Company is planning for in-home assessment volume to double, and potentially triple, over the next two years, and is actively investing in member-engagement and care-coordination capabilities to support that growth.

Advantmed was founded by Chief Executive Officer Akash Patel and Chief Operating Officer Jignesh (“Jig”) Patel who currently oversees operations across all three lines of business.

Position Summary

Advantmed is building a new healthcare offering focused on Care Coordination and Benefits Navigation and is seeking an experienced healthcare operator to build and lead the business from the ground up. This is a builder role, not a role overseeing an established operation: the mandate is to design the operating model, build the playbooks, stand up the technology and staffing infrastructure, hire and train the initial team, and take the offering from launch through execution.

Key Relationships

• Reports to - Chief Operations Officer
• Location - Remote within the United States
• Team at launch - Building out Team

VP, Care Management & Navigation - Responsibilities & Strategic Goals

This is a zero-to-one build. The VP owns the design, launch, and scaling of the Care Coordination and Benefits Navigation offering — from operating model and workflows through staffing, technology, and performance measurement — and is accountable for taking it from concept to a functioning, measurable business.

• Design the end-to-end operating model. Build member intake, assessment, segmentation, care planning, navigation, referral, follow-up, and case-closure workflows from a blank page, scoped to Medicare Advantage, Medicaid, and D-SNP populations.
• Build the operating infrastructure. Author the playbooks, SOPs, scripts, decision trees, and clinical and non-clinical escalation protocols the team will run on.
• Stand up staffing and capacity. Define care coordinator and navigator staffing, caseload, and capacity models, and hire and train the initial team against them.
• Establish performance infrastructure from day one. Build training, certification, quality assurance, and performance management programs, along with the KPIs and outcomes measurement the business will be run on.
• Define the technology footprint. Set the case management and technology requirements needed to run the operation, including any build-versus-buy decisions.
• Own member engagement. Design the outreach and engagement strategies that drive participation in navigation and care coordination services.
• Take the offering to launch and scale. Sequence the build so the business moves from concept to live operation, then scales staffing, process, and technology against real client volume — with client reporting and unit economics in place from the start.

Essential Qualifications

• 10+ years of healthcare operations experience, including direct ownership of care coordination, care management, member navigation, or population health programs.
• Strong working knowledge of Medicare Advantage, Medicaid, and/or D-SNP populations and the health-plan operating environment they sit within.
• Demonstrated experience building or significantly scaling a healthcare service operation — not solely managing an operation someone else designed.
• Track record developing workflows, SOPs, staffing and capacity models, training and certification programs, quality assurance, and performance metrics from a limited or non-existent starting point.
• Strong understanding of member engagement and outreach in a health-plan or care-coordination context.
• Comfortable moving fluidly between strategy and hands‑on execution — this role will not have a large team to delegate to at launch.
• A genuine builder mindset: energized by creating something from a blank page rather than optimizing an existing operation.

Compensation

• Compensation for this role will be determined based on the selected candidate's experience and qualifications.
• Health Care Plan (Medical, Dental & Vision)
• Annual Performance Bonus
• Retirement Plan (401k, IRA)
• Life Insurance (Basic, Voluntary & AD&D)
• Paid Time Off (Vacation, Sick & Public Holidays)
• Family Leave (Maternity, Paternity)
• Short Term & Long Term Disability
• Work From Home
• Wellness Resources