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Vice President Clinical Operations (NYC OR San Francisco)

Storm3
New York, NY Full Time
POSTED ON 3/3/2025
AVAILABLE BEFORE 5/28/2025

Title : VP of Clinical Operations

Location : Hybrid (NYC Metropolitan Area) or Remote San Francisco (Bay Area)

Base Salary : $200,000 - $250,000

Job Summary :

The VP Clinical Officer will lead the Health plan's clinical programs, focusing on health plan operations, NCQA accreditation, and HEDIS measures. This role involves managing a team of RNs, driving patient care strategies, and ensuring compliance with regulatory standards to improve member outcomes and clinical efficiency.

Key Responsibilities :

  • Clinical Leadership : Develop and manage clinical programs that align with health plan goals, improve HEDIS measures, and ensure NCQA compliance. Lead a team of RNs, ensuring best practices and regulatory adherence.
  • Operational Management : Oversee clinical operations, collaborate with cross-functional teams, and optimize resources. Develop population health, case management, and utilization management programs.
  • Quality & Compliance : Lead HEDIS program development and quality assurance efforts. Ensure compliance with federal, state, and NCQA standards for health plan accreditation.
  • Stakeholder Engagement : Communicate with stakeholders, including clinical staff, board members, and regulatory agencies. Represent the health plan in external forums.
  • Staff Development : Mentor and support the professional growth of clinical staff, particularly RNs, and ensure ongoing education and training.

Skills :

  • Strong leadership in clinical operations within a health plan.
  • Deep knowledge of NCQA standards, HEDIS measures, and healthcare regulations.
  • Excellent communication and team management skills.
  • Qualifications :

  • Bachelor of Science in Nursing (BSN) required; MSN preferred.
  • 10 years leading clinical operations in a health plan or complex healthcare organization, with experience in NCQA accreditation and HEDIS performance.
  • Proven experience managing and developing RN teams.
  • Salary : $200,000 - $250,000

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