Provides senior Health Plans leadership for clinical alignment across VNS Health Plans' clinical organization, internal Provider/Network teams and external provider and healthcare partners. Serves as the primary integration point for cross-functional clinical work requiring coordinated action across Health Plans and provider organizations, ensuring clinical priorities are translated into aligned provider-facing strategies, accountabilities and performance expectations. Builds senior relationships with hospitals, health systems, physician organizations, IPAs, delegated entities and other strategic partners and leads collaborative efforts to improve quality, utilization, care coordination, member outcomes and provider clinical performance. The role complements, rather than replaces, the accountabilities of Clinical Operations and Provider/Network leadership by providing the governance, integration and oversight required when clinical objectives span organizational boundaries.

What You Will Do:

Develops and leads the Health Plans approach for aligning clinical priorities with Provider/Network strategies and external provider activities and serves as the primary clinical integration point between Health Plans Clinical leadership and Provider/Network teams.

Translates Health Plans clinical strategy into coordinated provider-facing initiatives, objectives and performance expectations across quality, utilization, care management, transitions of care, population health and member outcomes.

Ensures provider perspectives, capabilities, barriers and opportunities inform Health Plans clinical planning and decision-making and identifies cross-functional dependencies that may impede achievement of clinical objectives.

Establishes governance, roles, decision rights, escalation pathways and accountability mechanisms for shared clinical priorities.

Builds and maintains senior relationships with clinical and operational leaders across key hospitals, health systems, physician groups, IPAs, delegated entities, community providers and other strategic partners in the New York market.

Represents VNS Health Plans' clinical priorities in strategic provider discussions and partners with Provider/Network leadership when quality, utilization, clinical performance or member outcomes are material components of the relationship.

Serves as a senior escalation point for complex clinical issues involving strategic provider partners and mobilizes internal and external stakeholders to resolve systemic barriers.

Partners with Clinical, Quality, Analytics and Provider/Network leaders to establish a coordinated approach to provider clinical performance and meaningful measures across quality, utilization, care management and member outcomes.

Identifies performance trends, variation and opportunities requiring intervention and works with provider organizations and internal leaders to establish improvement plans with clear objectives, owners, timelines and measures.

Monitors progress, escalates barriers and facilitates the sharing and scaling of effective provider practices across the Health Plans network where appropriate.

Provides leadership and oversight for complex clinical initiatives requiring coordinated execution across multiple VNS Health Plans functions and external provider organizations.

Establishes cross-functional workstreams, governance structures, decision rights and accountabilities and brings together Clinical, Provider/Network, Quality, Operations, Product, Analytics, Pharmacy, Compliance and other stakeholders to address shared priorities.

Facilitates resolution of issues where ownership crosses functions or organizations, makes recommendations on priorities and tradeoffs, and ensures risks and barriers are escalated to the appropriate Health Plans leaders.

Provides senior leadership with insights on provider clinical performance, cross-functional risks, external partner issues and opportunities to improve clinical outcomes and member experience.

Participates in special projects and performs other duties as assigned.

Qualifications

Licenses and Certifications: Clinical licensure (e.g., RN or other applicable clinical credential) preferred when relevant to the candidate's background and scope preferred

Education: Bachelor's Degree in Nursing, Healthcare Administration, Public Health, Business Administration or a related discipline required Master's Degree in Healthcare Administration, Public Health, Business Administration, Nursing or a related field preferred preferred

Work Experience:

Minimum 10 years of progressively responsible experience in managed care, health plan clinical operations, provider performance, population health, healthcare delivery or a related healthcare environment required

Significant experience working at the intersection of a health plan and provider organizations and leading complex cross-functional clinical initiatives required

Demonstrated experience engaging senior clinical and operational leaders within hospitals, health systems, physician organizations, IPAs or other provider entities required

Strong understanding of health plan clinical priorities, including quality, utilization management, care management, population health and member outcomes required

Demonstrated ability to establish governance, drive accountability and influence outcomes across matrixed teams without relying solely on direct authority required

Experience using provider and clinical performance data to identify opportunities and drive improvement required

Knowledge of Medicare and Medicaid managed care and the New York healthcare/provider market strongly preferred

Pay Range

USD $172,900.00 - USD $230,500.00 /Yr. About Us

VNS Health has been committed to meeting the needs of New Yorkers for over 130 years. We’re one of the largest nonprofit home- and community-based health care organizations in the country, and today, more than 11,500 team members work together to make a difference in the lives of more than 99,000 patients and members on any given day.