VP, Clinical Operations & Strategy

Medical Mutual; Cleveland (OH); On-site; USD 180,000 - 250,000; Full time

Benefits offered by this job

On-site fitness centers

Gym membership reimbursement

On-site cafeteria

Discounts for employees

Cash rewards program

Business casual attire

Job summary

Medical Mutual is seeking a Vice President of Clinical Services & Operations to lead Clinical Delivery teams and advance value-based care initiatives. You will report to the CMO and shape strategic clinical programs across priority areas including Prior Authorization, Acute and Post-Acute Care, and Case Management.

You will partner with leaders to optimize utilization, cost, quality, and member satisfaction, while guiding budget and communications to executives and stakeholders.

Qualifications

• RN with Ohio license required.
• 10 years progressive health care plan management experience including Medicare/Medicaid.
• Experience leading clinical delivery and value-based care initiatives.

Responsibilities

• Direct cross-functional teams to plan and implement division initiatives.
• Partner with VPs to advance clinical innovation and optimize strategies.
• Achieve medical management objectives for at‑risk populations.
• Promote cost-effective practice patterns with providers.
• Advise CMO on inquiries, communications and key meetings.
• Coordinate Division budget and prepare for CMO review.
• Oversee clinical content and program materials for utilization and case management.
• Oversee post-acute management of third-party providers.
• Represent Clinical Operations in customer and broker presentations.
• Perform additional duties as assigned.

Skills

Verbal communication

Written communication

Microsoft Office

Database reporting

Clinical systems

Strategic leadership

Budget management

Medicare knowledge

Provider engagement

Education

Bachelor's Degree in nursing or similar clinical area

Master's degree in Business or Health Care Administration or related field

Tools

N/A

Job description

Medical Mutual is seeking a Vice President of Clinical Services & Operations to lead Clinical Delivery teams and advance value-based care initiatives. You will report to the CMO and shape strategic clinical programs across priority areas including Prior Authorization, Acute and Post-Acute Care, and Case Management.

You will partner with leaders to optimize utilization, cost, quality, and member satisfaction, while guiding budget and communications to executives and stakeholders.