The VP Population Health Medical Services is responsible for oversight and execution for all clinical policies and processes, contributing to a whole person care approach to serve members. This leader will apply expertise in developing and utilizing key performance indicators to identify and investigate complex problems in various health care domains including physical health, behavioral health, and social determinants of life and health. This leader will support delivery of results on high-impact projects collaborating with various stakeholders and will identify opportunities for next best actions to improve processes and lower costs through both appropriate standardization and recognition of individual state market regulator nuances and requirements.

Currently this role will have oversight of Medicaid Markets with Medicaid Market Chief Medical Officer direct reports, as well as their organization that includes Behavioral Health Medical Directors, Plan Medical Directors, and other key market personnel.

This position will report directly to the Medical Services SVP & Associate CMO and is remote but will require some travel to corporate offices in Philadelphia, PA or to market offices, expecting travel approximately once per month.

Major accountabilities:

• Drive the organizations direction regarding models of care that incorporate needs of all markets, focusing on quality and operational efficiencies across the organization
• Development and maintenance of care guidelines that follow latest evidence based literature
• Coordinate with analytics team to develop risk stratification; create best practices for algorithms
• Oversee market CMOs; conduct education and training of market CMOs
• Ensure clinical and quality compliance with regulatory and accreditation requirements
• Coordinate with VBP/network teams to develop and implement VBP models
• Ensure process standardization across all markets
• Support RFP responses and evaluation and vetting of new vendor programs
• Identify opportunities for actions to improve the health of members and lower costs
• Providing support on clinical programs to ensure measurable positive outcomes.

Education/ Experience:

• MD
• Active, unrestricted State Licensure required
• 10 or more years clinical experience in the Healthcare industry, managed care preferred.
• Ability to develop, execute and improve clinical programs across large or multiple business units.
• Ability to identify, create and tracking clinical program opportunities for population health management.

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