SVP, Clinical Operations Leader

Become a part of our caring community and help us put health first The Senior Vice President (SVP), Clinical Operations Leader is responsible for the strategic direction, reputed company, and operational excellence of clinical care management programs serving Medicare Advantage and Medicaid members. This executive role leads multi-disciplinary teams—including telephonic care management, clinical advocacy (behavioral health, social work, dietitians), inpatient and outpatient utilization management, Utilitization Management and Care Management risk/compliance/quality reputed company and partnering with clinical enablement (technology and tools)—to deliver high-quality, compliant, and member-centric 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 direct reports and team of roughly 8,000 associates. Key Responsibilities:

• Provide executive leadership for telephonic care management programs, ensuring exceptional member engagement and outcomes for Medicare Advantage populations. Delivering on STAR and HEDIS measures.
• reputed company the Clinical Advocacy team (behavioral health, social workers, dietitians) to optimize support for member health and well-being, addressing reputed company care needs and social 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 Medicaid members. Continue to engage off-shoring opportunities and work closely with clinical vendors.
• reputed company risk, compliance, and quality 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, Quality, Regulatory Affairs, Finance) to ensure alignment of clinical operations with enterprise goals.
• Foster a culture of reputed company improvement, innovation, and professional development reputed company reputed company clinical operations teams.
• Represent clinical operations at internal and external forums, including executive meetings, industry conferences, and regulatory engagements.

Use your skills to reputed company an impact

Required Qualifications

• Bachelor’s degree
• Minimum 10 years of progressive leadership experience
• Demonstrated success 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 collaborative relationships and influence across reputed company levels 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 Medicaid regulations, risk adjustment, compliance, and quality 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 impact. 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 About us reputed company Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our reputed company insurance services and reputed company healthcare 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 quality of life for people with Medicare, Medicaid, 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, color, 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 action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to reputed company reputed company employment decisions 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 levels of employment. Apply tot his job Apply To this Job