Vice President, Clinical Operations

Job Summary:

The Vice President, Clinical Operations will oversee the design, implementation, and ongoing management of Antidote Health’s clinical programs, ensuring that such programs meet the healthcare needs of its members while complying with regulatory and NCQA accreditation standards. This role leads clinical staff, manages Antidote Health’s patient care strategies, and integrates clinical processes with business objectives.

Key Responsibilities:

Clinical Leadership and Strategy:

• Develop, implement, and manage clinical programs based on the populations served by Antidote Health.
• Develop and implement clinical and member engagement and intervention strategies and goals that align with Antidote Health’s goals.
• Lead clinical practice transformation with innovative solutions to improve patient outcomes.
• Oversee clinical team management, ensuring best practices and compliance with health plan regulations and accrediting standards.

Operational Management:

• Manage the day-to-day clinical operations, ensuring efficiency, effectiveness, and value for Antidote Health and its members.
• Collaborate with IT, Product, Marketing, and Operations departments to integrate clinical and operational systems.
• Develop and implement NCQA-compliant:
• Population health, including risk stratification and identification of Antidote Health’s members;
• Quality improvement;
• Complex case management (CCM); and
• Utilization management (UM) programs, including prior authorization, concurrent review of inpatient stays, retrospective reviews, adverse determinations, and appeals
• Optimize resource allocation, including staffing, budgets, and clinical tools.

Quality and Compliance:

• Lead the development of a robust HEDIS program.
• Oversee the quality assurance programs, including continuous improvement of clinical services.
• Ensure compliance with all federal and state regulations and accrediting standards of patient care and clinical operations, including NCQA-compliant delegation oversight of Antidote Health’s pharmacy benefits manager, UM, and CCM vendors.
• Monitor and report on health outcomes and quality metrics to the board, regulatory bodies, and accrediting agencies.
• Lead the NCQA Health Plan accreditation process, ensuring operational compliance with standards.

Stakeholder Engagement:

• Communicate effectively with all stakeholders, including medical staff, board members, regulatory agencies, accrediting bodies, and members.
• Represent the health plan in external forums and contribute to healthcare policy discussions.
• Management and leadership of Antidote Health clinical quality committee(s).

Staff Development:

• Lead the development of the on-boarding and training programs for Antidote Health’s clinicians.
• Foster a culture of professional growth and development among clinical staff.
• Provide mentorship and leadership to clinical teams, including physician leadership.
• Ensure ongoing clinical education and training to update staff on the latest healthcare advancements.

Skills:

• Strong leadership and organizational skills.
• Excellent communication and interpersonal skills.
• Deep understanding of clinical operations and healthcare regulations.

Desired Attributes:

• Strategic thinker with an ability to manage complex issues.
• Proven ability to lead and motivate a diverse team.
• High ethical standards and professionalism.

Training and Qualification

• Bachelor of Science in Nursing
• Master of Science in Nursing
• 10 + years of experience leading clinical operations in a health plan or complex healthcare organization.