Vice President, Population Health and Clinical Support

Position Description

Base pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more.

At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.” 

 

The Vice President of Population Health & Clinical Support leads the development and execution of Capital’s Population Health Strategy across all lines of business (LOB), with a strong focus on Government Programs (Medicare Advantage & ACA products). This role ensures that population health interventions are strategically measured and coordinated to optimize clinical outcomes, total cost of care, and member satisfaction, particularly in high-impact segments with significant P&L opportunities. This role reports to the CMO & Senior Management, ensuring that all population health strategies align with Capital’s overarching business objectives.

Responsibilities and Qualifications

Strategic Leadership and Cross-Functional Collaboration

• Works closely with clinical, business, and provider teams to integrate population health efforts into Capital’s Value Proposition, ensuring alignment with Government Programs, Provider Networks, Payment Integrity, and Marketing.
• Provides strategic and operational leadership to enhance HEDIS and STARs performance and optimize P&L outcomes for Government Programs through targeted population health management strategies. Collaborate cross-functionally to drive the development of innovative clinical interventions that support organizational goals and improve outcomes in key populations.
• Leads the RFP/Sales Support team, guiding clinical responses and presentations while advising the Product Team on clinical program evaluations.

Quality and Cost Optimization

• Drives improvements in HEDIS and STARs ratings, enhances Total Cost of Care management, supports Risk Adjustment strategies, and ensures strong financial performance across LOBs.
• Supports Medical Informatics, Actuarial, and Cost of Care teams in analyzing utilization trends, evaluating clinical programs, and guiding outcomes methodology.
• Utilizes system technology for clinical tracking and implementation, leads priority initiatives, and assesses risks affecting clinical program success.

Operational Oversight & Compliance

• Ensures adherence to Population Health Management standards in partnership with the Accreditation Unit, oversees delegated vendor activities, and supports internal education on population health initiatives.
• Works with Accreditation, Quality Improvement Committees, and internal teams to ensure standards and quality measures are met for population health initiatives.
• Supports the Population Health Management Strategy across all lines of business (LOBs), with a strong emphasis on key programs such as Medicare Advantage.
• Partners with vendors to deliver population health management services, ensures contractual and delegation requirements are met, and collaborates with internal teams to optimize interventions.

Corporate and Community Engagement

• Actively participates in Total Cost of Care Leadership, strategic planning, and corporate initiatives, while representing Capital in the medical provider community and supporting Sales and Marketing efforts.

Skills: 

• Demonstrated public speaking and written communication skills.
• Computer literate with the ability to process requests on-line.
• Microsoft applications; outlook, word, excel, visio, project proficient.
• Problem solving and critical thinking skills with ability to determine best approach.
• Team player; ability to work cross-functionally.
• Mentor/coaching skills.
• Leadership: Able to work effectively with all areas of the company, providing clinical and organizational leadership. Excellent interpersonal skills and professional demeanor. Ability to drive action and results on a cross functional basis.