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The VP, Medicaid Clinical Operations is an enterprise executive responsible for leading Medicaid clinical operations, utilization management, care management/service coordination, and clinical program delivery across Medicaid markets. This leader translates Medicaid strategy, market requirements, quality priorities, and regulatory expectations into standardized operating models, scalable workflows, measurable performance outcomes, and ensures operational excellence. The role is accountable for operational execution, clinical program performance, workforce productivity, compliance, quality, cost, access, member experience, provider experience, and risk management across complex Medicaid populations, while partnering with Product, Technology, Data, and Analytics teams to ensure Clinical Operations needs are effectively translated into technology requirements and enabled solutions.

               

This position is remote.  However strong preference will be given to candidates residing in Tampa, FL or Louisville, KY.

Key Responsibilities:

Clinical Operations Leadership

• Lead Medicaid Clinical Operations, including clinical and nonclinical teams supporting utilization management, care management/service coordination, program operations, process improvement, training, and project execution.
• Establish clear operating rhythms, accountability structures, workforce productivity expectations, and performance management processes across distributed clinical operations teams.
• Build and sustain an engaged, high-performing leadership culture focused on associate development, retention, operational discipline, and measurable outcomes.

Healthcare Transformation and Strategy

• Develop and execute Medicaid clinical operations strategies that support growth, market expansion, state contract requirements, enterprise priorities, and scalable operating model transformation.
• Translate clinical strategy, market commitments, and program designs into operational workflows, staffing models, performance targets, and implementation plans.
• Lead operational readiness and implementation for new Medicaid markets, expanded programs, and enterprise transformation initiatives.
• Drive standardization, workflow optimization, and continuous improvement to improve scalability, consistency, and performance across markets.

Utilization Management, Care Management, and Integrated Care Delivery Clinical Operations

• Oversee Medicaid utilization management and care management/service coordination functions, ensuring consistent clinical practices, regulatory compliance, timely decision-making, and appropriate escalation management.
• Advance integrated care models that address physical health, behavioral health, long-term services and support, social needs, and complex population health needs.
• Strengthen care navigation, member access, provider coordination, and interventions that reduce avoidable utilization and improve health outcomes.
• Partner with physician leadership, nursing leadership, behavioral health, quality, market, Medicare, and functional teams to align clinical programs and support dual-eligible and complex member populations.

Performance, Financial, Risk Management and Technology Partnership

• Partner with Product, Technology, Data, Analytics, and Operations teams to translate Clinical Operation’s needs, regulatory requirements, workflow gaps, and performance priorities into clear business requirements, use cases, and solution expectations.
• Provide clinical operational input into technology roadmaps, solution design, workflow enablement, reporting needs, user adoption considerations, and post-implementation performance feedback.
• Ensure technology-enabled solutions support standardized clinical workflows, accurate reporting, operational scalability, associate effectiveness, care coordination, and measurable clinical operations outcomes.

Cross-Functional and Matrixed Partnerships

• Establish, monitor, and improve key performance metrics, including quality, compliance, cost of care, access, utilization, productivity, service levels, member experience, provider experience, revenue, margin, and client or contract performance commitments.
• Partner with Finance to manage budgets, staffing models, labor efficiency, investment priorities, and operating performance.
• Identify performance gaps, assess clinical and operational risk, and implement mitigation plans, corrective actions, and sustainable performance improvement routines.
• Serve as a key escalation and decision authority, provid