Vice President, Population Health Management
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Overview
Job Description
This is a hybrid position in Huntington Beach, CA. Candidate must resident in Los Angeles, Orange County or surrounding areas.
Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California's fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth.
Who Are We?
Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members' culture and values.
Why Join Us?
We're on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you'll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation.
Job Summary
The Vice President of Population Health Management (PHM) provides enterprise-wide leadership for strategies that integrate utilization management, care management, and population health initiatives to improve quality, affordability, and member health outcomes. This role drives clinical and operational performance through data-driven interventions, regulatory compliance, and value-based partnerships, while incorporating Social Determinants of Health and health equity considerations into population health strategies and leveraging analytics for predictive modeling and risk stratification.
Functions & Job Responsibilities
Population Health Strategy & Executive Clinical Partnership
Leads the development and execution of the enterprise Population Health Management (PHM) strategy in close partnership with the Health Plan Chief Medical Officer, aligning utilization management, care management, quality, and population health priorities to improve outcomes, affordability, and regulatory performance.
Clinical Performance, Quality & Population Health Outcomes
Provides executive oversight of clinical performance across population health programs, including the development and oversight of disease management initiatives, ensuring evidence-based care models, quality outcomes, and regulatory performance, including Medicare Advantage quality measures such as Stars, HEDIS, and CAHPS, are embedded into program design, execution, and ongoing performance monitoring.
Provider, IPA & MSO Partnership Governance
In partnership with the Health Plan Chief Medical Officer, leads joint operational governance with IPAs and MSOs, including oversight of utilization management and care management functions, performance reporting, and accountability for agreed-upon clinical, quality, and cost outcomes.
Data, Analytics & Risk Stratification Enablement
Provides strategic direction for the use of analytics, predictive modeling, and risk stratification to inform population health interventions, guide resource allocation, and enable data-driven decision-making across utilization management, care management, and quality initiatives.
Operational Leadership, Team Development & Vendor Oversight
Provides strategic guidance, direction, and overall leadership of utilization management and care management teams and processes in support of the enterprise population health strategy; leads and mentors teams, builds workforce and succession plans for critical roles, and oversees population health vendors and platforms to ensure performance accountability, operational readiness, and regulatory compliance
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