Vice President, Medicare Care Management (Remote)

Lead the national Medicare Care Management organization, including regional operations, transitions of care, complex care management, duals care management, and specialty programs.

• Develop and execute the enterprise care management strategy to improve clinical outcomes, member experience, Star Ratings, and medical cost performance.
• Align care management programs with Medicare Advantage growth, quality, utilization management, LTSS, and value-based care strategies.
• Partner with executive leadership to establish priorities, performance goals, and multi-year transformation roadmaps.
• Accountable for Model of Care (MOC) performance, compliance, audit readiness, and regulatory outcomes.
• Drive operational excellence through standardized workflows, consistent clinical practices, and performance management across markets.
• Lead continuous improvement efforts focused on reducing unnecessary variation and improving member outcomes.
• Ensure care management programs demonstrate measurable impact on quality, utilization, member engagement, and total cost of care.
• Develop and oversee programs supporting transitions of care, complex care management, chronic condition management, behavioral health integration, and duals populations.
• Identify and implement opportunities to reduce avoidable admissions, readmissions, emergency department utilization, and post-acute care costs.
• Partner closely with Utilization Management, Medical Economics, Network, Pharmacy, and Quality leaders to deliver annual QAI and affordability targets.
• Translate clinical insights into scalable interventions that improve health outcomes while managing medical expense.
• Lead modernization of care management capabilities through workflow automation, digital engagement, AI-enabled clinical support, and analytics.
• Partner with technology teams to improve clinical platforms, reporting, interoperability, and workforce productivity.
• Drive adoption of data-driven decision making and ad