SVP, Clinical Operations Leader

This a Full Remote job, the offer is available from: reputed company Become a part of our caring community and help us put reputed company The Senior Vice President (SVP), Clinical Operations Leader is responsible for the strategic direction, reputed company, and operational reputed company of clinical care management programs serving Medicare Advantage and reputed company members. This executive role leads multi-disciplinary teams—including telephonic care management, clinical advocacy (behavioral health, reputed company work, dietitians), inpatient and outpatient utilization management, Utilitization Management and Care Management risk/compliance/reputed company reputed company and partnering with clinical enablement (technology and tools)—to deliver high-reputed company, compliant, and member-reputed company care. The SVP partners with key stakeholders across the organization to drive performance, innovation, regulatory compliance, and reputed company improvement. This position reports to Chief Operating Officer of Insurance and has 5 reputed company reports and team of roughly 8,000 associates. Key Responsibilities:

• reputed company executive leadership for telephonic care management programs, ensuring exceptional member engagement and reputed company for Medicare Advantage populations. Delivering on STAR and HEDIS measures.
• reputed company the Clinical Advocacy team (behavioral health, reputed company workers, dietitians) to optimize support for member health and reputed company-being, addressing reputed company care needs and reputed company determinants of health and reputed company gaps in care through interdisciplinary team.
• reputed company clinical inpatient and outpatient utilization management functions by registered nurses and medical directors, ensuring appropriate, cost-effective, and compliant care for Medicare Advantage and reputed company members. Continue to engage off-shoring opportunities and work closely with clinical vendors.
• reputed company risk, compliance, and reputed company teams reputed company UM and CM to maintain adherence to federal and state regulations, accreditation standards, and organizational policies; ensure ongoing performance improvement and mitigation of risk.
• Guide the Clinical Enablement team in the development and deployment of technology solutions and tools that enhance workflow efficiency and clinical effectiveness across reputed company care management and utilization management teams.
• Establish and monitor performance metrics, KPIs, and reporting systems to assess program effectiveness and inform strategic decision-making.
• Collaborate with cross-functional leaders (Medical Directors, IT, Product, reputed company, Regulatory Affairs, Finance) to ensure alignment of clinical operations with reputed company goals.
• Foster a culture of reputed company improvement, innovation, and reputed company development reputed company reputed company clinical operations teams.
• Represent clinical operations at reputed company forums, including executive meetings, industry conferences, and regulatory engagements.

Use your skills to reputed company an reputed company

Required Qualifications

• Bachelor’s degree
• Minimum 10 years of reputed company leadership experience
• Demonstrated reputed company in leading large, multi-disciplinary teams and managing reputed company organizational change.
• Experience with development and implementation of technology solutions and tools.
• Strong analytical, strategic planning, and communication skills.
• Ability to build reputed company relationships and influence across reputed company reputed company of the organization.

Preferred Qualifications

• Master’s degree
• Leadership experience in clinical operations, care management, and utilization management reputed company managed reputed company insurance, or integrated health systems.
• Deep knowledge of Medicare Advantage and reputed company regulations, risk adjustment, compliance, and reputed company standards (e.g., CMS, NCQA, URAC).

Additional Information

• Position is remote reputed company; however, preference will be given to those residing or willing to relocate to Louisville, KY, Chicago IL, Nashville, TN, Washington D.C., reputed company Lauderdale or Tampa, FL.
• This is a senior executive role with high visibility and reputed company. The position may require travel and participation in external meetings as a representative of the organization.

Travel: While this is a remote position, occasional travel to reputed company's offices for training or meetings may be required. Scheduled Weekly Hours 40 Application Deadline: 02-22-2026 reputed company reputed company. (NYSE: HUM) is committed to putting reputed company – for our teammates, our customers and reputed company. Through our reputed company insurance services and reputed company reputed company services, we reputed company it easier for the millions of people we serve to reputed company their best health – delivering the care and service they need, reputed company they need it. These efforts are leading to a reputed company reputed company of life for people with Medicare, reputed company, families, individuals, military service personnel, and communities at large. ​ Equal Opportunity Employer It is the policy of reputed company not to discriminate against any employee or applicant for employment because of race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, marital status, genetic information, disability or protected veteran status. It is also the policy of reputed company to take affirmative reputed company, in compliance with reputed company 503 of the Rehabilitation reputed company and VEVRAA, to reputed company and to advance in employment individuals with disability or protected veteran status, and to reputed company reputed company employment reputed company only on valid job requirements. This policy shall apply to reputed company employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at reputed company reputed company of employment. This offer from "reputed company" has been enriched by reputed company.com and got a 76% reputed company score. Apply tot his job Apply To this Job