VP, Clinical Operations

Alignment Health; Georgia; On-site; USD 150,000 - 210,000; Full time

Job summary

Alignment Health seeks a proven VP of Clinical Operations to lead strategic development of clinical programs, improve patient outcomes, and optimize value-based care across transitions of care.

You will oversee program design, vendor collaboration, and performance improvement, aligning CMS/HEDIS/STAR metrics with corporate goals while mentoring leaders and building high-performing teams.

Qualifications

• 5+ years of progressive leadership experience in care management, population health, or clinical operations.
• Deep understanding of Medicare Advantage regulations, Transitional Care Management (TCM), STARS and HEDIS metrics, and value-based care models.
• Experience leveraging analytics and technology and embedding care management modules inside EHR systems.
• Deep understanding of utilization management, care management, and risk adjustment functions.
• Master’s degree (or higher) in Healthcare Administration, Nursing, Public Health, or related field
• Strong analytical mindset and comfort interpreting clinical and financial data.
• Demonstrated commitment to innovation, member-centric care, and continuous improvement.

Responsibilities

• Develop and execute a comprehensive clinical strategy that supports medical cost management, quality performance, and member engagement goals.
• Design end-to-end transitional care management (TCM) programs that engage high-risk patients before hospitalization and safely transition them to the appropriate setting.
• Lead cross-functional initiatives integrating clinical operations, population health, risk adjustment, and quality improvement programs.
• Evaluate and recommend emerging technologies—AI-driven triage, clinical decision support, remote monitoring, and telehealth to improve member outcomes and program efficiency.
• Partner with provider networks and care management teams to enhance care coordination, reduce avoidable utilization, and improve chronic disease management.

Skills

Leadership

Medicare Advantage

Care management

Analytics

Value-based care

EHR integration

Education

Master’s degree in Healthcare Administration / Nursing / Public Health

Tools

EHR systems

Analytics platforms

Job description

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. The Vice President of Clinical Operations is responsible for the strategic development, design, and continuous improvement of clinical programs, interventions, and health initiatives for our value-based care (VBC) arrangements. This leader will focus heavily on the holistic management of patients across the continuum of care, specifically optimizing pre-hospitalization interventions and post-acute transitions of care to ensuring that the patient outcomes align with corporate strategy, regulatory requirements, and the organization’s mission to improve member health, enhance member experience, and optimize medical cost performance.

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. The Vice President of Clinical Operations is responsible for the strategic development, design, and continuous improvement of clinical programs, interventions, and health initiatives for our value-based care (VBC) arrangements. This leader will focus heavily on the holistic management of patients across the continuum of care, specifically optimizing pre-hospitalization interventions and post-acute transitions of care to ensuring that the patient outcomes align with corporate strategy, regulatory requirements, and the organization’s mission to improve member health, enhance member experience, and optimize medical cost performance.

Key Responsibilities

• Develop and execute a comprehensive clinical strategy that supports medical cost management, quality performance (e.g., STAR ratings, HEDIS, CAHPS), and member engagement goals.
• Design end-to-end transitional care management (TCM) programs that proactively engage high-risk patients before hospitalization and safely transition them to the appropriate setting.
• Design, implement, and continuously refine evidence-based clinical protocols and interventions for chronic disease management, predictive risk-stratification, and social determinants of health (SDOH) tracking.
• Lead cross-functional initiatives integrating clinical operations, population health, risk adjustment, and quality improvement programs.
• Evaluate and recommend emerging technologies—AI-driven triage, clinical decision support, remote monitoring, and telehealth to improve member outcomes and program efficiency.

Clinical Program Oversight & Performance

• monitor performance and ensure continuous quality improvement.
• Ensure ongoing alignment of clinical program strategies with CMS, HEDIS, CAHPS, HOS, Stars, and risk adjustment requirements with a focus on optimizing Medicare Advantage performance.
• Partner with provider networks and care management teams to enhance care coordination, reduce avoidable utilization, and improve chronic disease management.
• performance is monitored rigorously, and outcomes are delivered reliably.
• Develop leaders who excel in operational performance management, problem solving, and talent development.

Vendor Management

• Establish performance expectations and metrics for vendor partners; Facilitate cross-functional collaboration with vendors, internal analytics, and clinical teams to optimize program performance.

Operational Excellence & Continuous Improvement

• Implement process improvement methodologies to streamline clinical operations and optimize resource utilization.
• Drive adoption of technology and data solutions that enable precision targeting, automation, and real-time insights.
• Work cross-functionally with key leaders in Clinical, Quality, Provider/Network, and Actuarial to align clinical optimization initiatives with organizational goals.
• Serve as a strategic advisor to the executive team on trends in population health management, value-based care, and clinical innovation.
• Build strong relationships with providers, vendors, and community partners to advance shared clinical outcomes.

Recruitment & Talent Development

Responsibilities include recruiting, selecting, orienting, and training employees; planning, monitoring, and appraising job results; and coaching, counseling, and performance management.

Qualifications

• 5+ years of progressive leadership experience in care management, population health, or clinical operations, with a proven track record of managing operations under at-risk, ACO, or capitated payer contracts.
• ~ Deep understanding of Medicare Advantage regulations, Transitional Care Management (TCM), STARS and HEDIS metrics, and value-based care models.
• ~ Experience leveraging analytics and technology and embedding care management modules inside EHR systems.
• ~ Deep understanding of utilization management, care management, and risk adjustment functions.
• Master’s degree (or higher) in Healthcare Administration, Nursing, Public Health, or related field
• Strong analytical mindset and comfort interpreting clinical and financial data.
• Demonstrated commitment to innovation, member-centric care, and continuous improvement.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.