Get new jobs for this search by email

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 .

Seniority level

• Seniority level

  Executive

Employment type

• Employment type

  Full-time

Job function

• Job function

  Research, Analyst, and Information Technology

• Industries

  Hospitals and Health Care

Referrals increase your chances of interviewing at Antidote Health by 2x

Get notified about new Vice President Clinical Operations jobs in New York City Metropolitan Area.

Vice President, Clinical Development – Gene Therapy

Bridgewater, NJ $387,000.00-$451,000.00 4 days ago

Vice President, Communications Operations and Business Management

Vice President, Therapeutic Area Lead - CVRM Clinical Development

New York City Metropolitan Area $140,000.00-$180,000.00 3 weeks ago

Vice President, Investment Operations - Alternative Credit

New York, NY $150,000.00-$195,000.00 2 months ago

Vice President, Therapeutic Area Lead - CVRM Clinical Development

Futures Operations & Clearing Vice President

VP - Direct Lending Operations - Private Credit Business

New York, NY $150,000.00-$200,000.00 1 week ago

Vice President – Finance and Banking Operations Auditor

Vice President of Clinical Operations (Remote)

New York City Metropolitan Area 3 weeks ago

Vice President, Global Clinical Operations

VICE PRESIDENT, OPERATIONS - OBMC / RBMC

Director, Clinical Strategy and Operations

Director, Clinical Operations Study Management

Jersey City, NJ $226,000.00-$247,000.00 2 weeks ago

New York, NY $130,000.00-$150,000.00 1 month ago

Vice President, Operations - OBMC / RBMC

Director of Clinical Operations- Mental Health

Vice President of Residential Operations

Director Clinical Operations Rare Disease

New York City Metropolitan Area $150,000.00-$200,000.00 2 days ago

New York, NY $120,000.00-$220,000.00 1 month ago

Director, Clinical Operations Program Lead

Princeton, NJ $195,000.00-$246,000.00 5 hours ago

We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.