Vice President of Clinical Operations

Vice President of Clinical Operations

About the Company

Leading provider of innovative self-insured healthcare plans for SMBs

Industry

Hospital & Health Care

Type

Privately Held

Founded

2015

Employees

201-500

Specialties

• health plan
• health insurance
• health plan health insurance
• health plan and health insurance

Business Classifications

About the Role

The Company is seeking a VP of Clinical Operations to provide dynamic leadership and oversight for its clinical services and casualty departments. The successful candidate will be a key stakeholder in the delivery of quality-driven, clinically effective, and cost-effective services, with a focus on meeting the needs of commercial and worker's compensation self-funded clients. This role requires a passionate individual with a strong clinical background, including a current RN, NP, or PA license, and a minimum of 4 years' clinical experience. The VP will be responsible for the design and implementation of departmental processes and services, ensuring compliance with regulatory and statutory requirements, and driving high-cost and payment integrity initiatives. Collaboration with the Chief Medical Officer and other departments is essential, as is the ability to influence outcomes and lead a clinical team. Candidates for the VP of Clinical Operations position at the company should have a proven track record in clinical team management, with previous experience in utilization management and a preference for those with a background in case management and workers' compensation. The role demands a leader who is approachable, positive, and team-focused, with the ability to collaborate across the organization and demonstrate strong problem-solving and decision-making skills. The VP will also be involved in staff training, performance evaluation, and maintaining professional relationships with clients and vendors. A general knowledge of HIPAA confidentiality laws is required, and the ability to work proficiently with Microsoft Word and Excel is a must. The company is an equal-opportunity employer and is dedicated to a culture of diversity, inclusion, and a sense of belonging.

Hiring Manager Title

Chief Medical Officer

Travel Percent

Less than 10%

Functions