VP of Clinical Operations & Value-Based Care

Alignment Health; Athens (GA); On-site; USD 180,000 - 320,000; Full time

Job summary

Alignment Health is seeking a strategic, senior leader to drive clinical programs and health initiatives within our value-based care framework. The Vice President of Clinical Operations will shape program design, oversee transitions of care, and ensure outcomes align with CMS requirements and our mission to improve member health and reduce costs.

This role leads cross-functional teams, refines evidence-based protocols, and explores AI-driven triage, remote monitoring, and telehealth to boost

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.

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.

Skills

Leadership

Care management

Population health

Healthcare analytics

CMS/HEDIS knowledge

Vendor management

Strategic planning

Data-driven decision making

Regulatory compliance

Education

Master’s degree in Healthcare Administration or related field

Tools

Epic EHR

SQL

Tableau

Power BI

Job description

Alignment Health is seeking a strategic, senior leader to drive clinical programs and health initiatives within our value-based care framework. The Vice President of Clinical Operations will shape program design, oversee transitions of care, and ensure outcomes align with CMS requirements and our mission to improve member health and reduce costs.

This role leads cross-functional teams, refines evidence-based protocols, and explores AI-driven triage, remote monitoring, and telehealth to boost