Vice President of Clinical Services

Vice President of Clinical Services

About the Company

Leading provider of innovative self-insured healthcare plans for SMBs

Industry

Hospital & Health Care

Type

Privately Held

Founded

2015

Employees

201-500

Specialties

• health plan
• health insurance
• health plan health insurance
• health plan and health insurance

Business Classifications

About the Role

The Company is seeking a VP of Clinical Services to provide dynamic leadership and oversight for its clinical and casualty departments. The successful candidate will be a key stakeholder in the delivery of quality-driven, clinically effective, and cost-effective services, with a focus on meeting the needs of commercial and worker's compensation self-funded clients. This role requires a passionate individual with a strong clinical background, including a current RN, NP, or PA license, and a minimum of 4 years' clinical experience. The VP will be responsible for the design and implementation of departmental processes, ensuring compliance with regulatory and statutory requirements, and driving high-cost and payment integrity initiatives. Collaboration with the Chief Medical Officer is essential for continuous process and quality improvement, as well as for the development of metrics leading to staff accountability.

Candidates for the VP of Clinical Services position at the company should have a proven track record in clinical team management, with previous experience in utilization management and a preference for those with a background in case management and workers' compensation. The role demands an individual with the ability to influence outcomes, a hands-on and team-focused work style, and a strong commitment to making healthcare more effective and affordable. Essential qualifications include the ability to define and solve problems, make effective decisions, and work proficiently with data analysis and performance metrics. The VP will also be responsible for staff training, development, and performance evaluation, and must maintain professional relationships with all clients and vendors.

Hiring Manager Title

Chief Medical Officer

Travel Percent

Less than 10%

Functions