AVP, Care Anywhere – High Risk Case Management
Job Description:
• Provide strategic and operational leadership for enterprise-wide complex case management programs serving clinically vulnerable Medicare Advantage members
• Drive measurable improvements in quality outcomes, total cost of care, utilization efficiency, member experience, and risk adjustment accuracy
• Partner closely with Clinical Operations, Medical Directors, Quality, Risk Adjustment, Network, Analytics, and Vendor Management to design and scale high-impact interventions
• Ensure programs align with CMS requirements, MA Star Ratings, HEDIS, CAHPS, and evolving end-of-life best practices
• Champion a member- and caregiver-centered approach, improving satisfaction and reducing care fragmentation
• Collaborate with Medical Directors and Clinical leaders to ensure appropriate intensity of care, hospice and palliative referrals, and site-of-care optimization
• Educate clinical teams on the intersection of complex care, end-of-life care, and risk adjustment accuracy without compromising care integrity
• Establish performance standards, KPIs, and outcomes dashboards for complex case management programs
• Mentor and develop clinical leaders, fostering a culture of accountability, compassion, and continuous improvement
Requirements:
• 8+ years of progressive leadership experience in case management, population health, or medical management
• Deep experience with Medicare Advantage, including CMS regulations, Stars, HEDIS, and MA quality frameworks
• Demonstrated expertise in complex care management, high-risk populations, palliative care, and/or end-of-life care
• Strong understanding of utilization management, total cost of care drivers, and value-based care models
• Working knowledge of risk adjustment (HCCs) and clinical documentation improvement in MA populations
• Proven ability to lead large, distributed clinical teams and influence across matrixed organizations
• Master’s degree in Healthcare Administration, Public Health, or related field
• Clinical licensure (e.g., RN, NP, MD, DO) preferred
• Lean Six Sigma, other processes improvement certification, Certified Professional in Healthcare Quality (CPHQ), or Certified Professional in Healthcare Management (CPHM) preferred
Benefits:
• Health insurance
• Retirement plans
• Paid time off
• Flexible work arrangements
• Professional development
Apply Now
Apply Now
• Provide strategic and operational leadership for enterprise-wide complex case management programs serving clinically vulnerable Medicare Advantage members
• Drive measurable improvements in quality outcomes, total cost of care, utilization efficiency, member experience, and risk adjustment accuracy
• Partner closely with Clinical Operations, Medical Directors, Quality, Risk Adjustment, Network, Analytics, and Vendor Management to design and scale high-impact interventions
• Ensure programs align with CMS requirements, MA Star Ratings, HEDIS, CAHPS, and evolving end-of-life best practices
• Champion a member- and caregiver-centered approach, improving satisfaction and reducing care fragmentation
• Collaborate with Medical Directors and Clinical leaders to ensure appropriate intensity of care, hospice and palliative referrals, and site-of-care optimization
• Educate clinical teams on the intersection of complex care, end-of-life care, and risk adjustment accuracy without compromising care integrity
• Establish performance standards, KPIs, and outcomes dashboards for complex case management programs
• Mentor and develop clinical leaders, fostering a culture of accountability, compassion, and continuous improvement
Requirements:
• 8+ years of progressive leadership experience in case management, population health, or medical management
• Deep experience with Medicare Advantage, including CMS regulations, Stars, HEDIS, and MA quality frameworks
• Demonstrated expertise in complex care management, high-risk populations, palliative care, and/or end-of-life care
• Strong understanding of utilization management, total cost of care drivers, and value-based care models
• Working knowledge of risk adjustment (HCCs) and clinical documentation improvement in MA populations
• Proven ability to lead large, distributed clinical teams and influence across matrixed organizations
• Master’s degree in Healthcare Administration, Public Health, or related field
• Clinical licensure (e.g., RN, NP, MD, DO) preferred
• Lean Six Sigma, other processes improvement certification, Certified Professional in Healthcare Quality (CPHQ), or Certified Professional in Healthcare Management (CPHM) preferred
Benefits:
• Health insurance
• Retirement plans
• Paid time off
• Flexible work arrangements
• Professional development
Apply Now
Apply Now