Vice President, Population Health & Clinical Operations

Centene Corporation • Massachusetts, Massachusetts • 9h ago

Centene is transforming the health of our communities one person at a time. As an Executive on our team, you could be the one who changes everything for our 28 million members.

Position Purpose:

In partnership with the CMO, serve as a key stakeholder, decision maker, and catalyst, for all market level population health identification, strategy, evaluation, and monitoring to achieve the Quadruple Aim and drive Centene's Population Health mission at the market level.

Provide strategic leadership for population health internally, as well as with providers, community organizations, advocacy groups, and applicable legislature.

Understand the local healthcare landscape to look for key drivers & opportunities for innovative models targeting the Quadruple Aim.

Understand the unique community health needs and the attributes of the populations served to drive development of programs and service.

Uses analytics to identify key insights about the populations served and drive the development of the interventions to target unique populations.

Oversees performance of all UM functions (prior authorization, concurrent review) for the market per the defined partnership agreement; co-leads agenda planning and annual performance goal setting, unique to market needs

Orchestrates all elements of the population health strategy for the business

Drives MLR initiatives locally through strong partnership and routine with Finance

Partner with the Special Investigations Unit (SIU) to proactively identify patterns of potential fraud, waste, and abuse (FWA) through clinical, claims, and utilization data insights, ensuring timely escalation and coordinated mitigation strategies. Additionally, NHHF will integrate SIU-driven findings into Population Health & UM operational workflows, informing policy updates, provider education, and process improvements to prevent recurrence of FWA and enhance overall compliance and accountability.

Partners with MDs to translate the needs of the members into intentional clinical program design that delivers successful health outcomes

Liaises with state regulators for clinical programs; proactively reviews and evaluates the utility, performance and ROI of clinical programs and acts as lead/champion to drive awareness and advocacy where needed

Develops comprehensive position papers-supported by clear rationale, data analysis, and documented recommendations-to advocate for program enhancements and strategic changes with internal and external stakeholders.

Coordinates quality initiatives (audits, star ratings, contract reviews, etc.) and activate enterprise and local policies

Informs and executes against contracts (including provider contracts) - driving outcomes captured in contract and operationalizing locally

Contributing member of enterprise and local committees

Serves as an integral member of the executive leadership team, charged with delivering clinical solutions to evolving business needs

Executes on standards and customizing per local requirements while partnering with the COEs to drive continuous improvement through governance and performance monitoring.

Education/Experience:

Bachelor's Degree with 5+ years of relevant experience required.

Master's Degree preferred.

Current state RN license preferred.

research, health policy, information technology or other relevant field. Must have at least five years of progressively responsible professional experience in population health, service coordination, ambulatory care, community health, case or care management, or coordinating care across multiple settings and with multiple providers. Proven leadership in a large, matrixed organization with 3-5 years of experience working with state or federal regulators

Pay Range: $171,900.00 - $326,900.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

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