VP, Clinical Operations & Value‑Based Care Innovation

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 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.