Job Closed

This listing is no longer active.

AVP, Care Anywhere – High Risk Case Management

RiskRiskOtherRemoteLeadTeam 501-1,000Since 2013H1B No SponsorCompany SiteLinkedIn

Location

United States

Posted

131 days ago

Salary

$198.2K - $297.3K / year

Seniority

Lead

Postgraduate Degree8 yrs expEnglish

Job Description

AVP, Care Anywhere – High Risk Case Management

Alignment Health

• Provide strategic and operational leadership for enterprise-wide complex case management programs serving clinically vulnerable Medicare Advantage members • Drive measurable improvements in quality outcomes, total cost of care, utilization efficiency, member experience, and risk adjustment accuracy • Partner closely with Clinical Operations, Medical Directors, Quality, Risk Adjustment, Network, Analytics, and Vendor Management to design and scale high-impact interventions • Ensure programs align with CMS requirements, MA Star Ratings, HEDIS, CAHPS, and evolving end-of-life best practices • Champion a member- and caregiver-centered approach, improving satisfaction and reducing care fragmentation • Collaborate with Medical Directors and Clinical leaders to ensure appropriate intensity of care, hospice and palliative referrals, and site-of-care optimization • Educate clinical teams on the intersection of complex care, end-of-life care, and risk adjustment accuracy without compromising care integrity • Establish performance standards, KPIs, and outcomes dashboards for complex case management programs • Mentor and develop clinical leaders, fostering a culture of accountability, compassion, and continuous improvement

Job Requirements

  • 8+ years of progressive leadership experience in case management, population health, or medical management
  • Deep experience with Medicare Advantage, including CMS regulations, Stars, HEDIS, and MA quality frameworks
  • Demonstrated expertise in complex care management, high-risk populations, palliative care, and/or end-of-life care
  • Strong understanding of utilization management, total cost of care drivers, and value-based care models
  • Working knowledge of risk adjustment (HCCs) and clinical documentation improvement in MA populations
  • Proven ability to lead large, distributed clinical teams and influence across matrixed organizations
  • Master’s degree in Healthcare Administration, Public Health, or related field
  • Clinical licensure (e.g., RN, NP, MD, DO) preferred
  • Lean Six Sigma, other processes improvement certification, Certified Professional in Healthcare Quality (CPHQ), or Certified Professional in Healthcare Management (CPHM) preferred

Benefits

  • Health insurance
  • Retirement plans
  • Paid time off
  • Flexible work arrangements
  • Professional development

Related Categories

Related Job Pages

More Risk Jobs

OtherRemoteTeam 10,001+Since 2010H1B No Sponsor

• Develop, maintain and implement assigned GxP/Quality incident management processes that align with organizational goals and latest regulatory requirements on global level. • Manage and oversee the intake, triage, investigation, documentation, and resolution of GxP and quality-related issues and incidents in an end-to-end process. • Partner with manufacturing, quality assurance, quality control, regulatory affairs, clinical operations, development, patient safety and other stakeholders to ensure timely and thorough management of GxP and quality incidents. • Drive and support comprehensive root cause investigations and the development of corrective and preventive actions plans and lessons learned related to escalated GxP and Quality incidents. • Ensure that the activities and documentation meet the relevant regulatory agency and other relevant requirements for the industry; prepare for and support inspections and audits. • Develop and deliver training on incident management procedures and promote a culture of quality and accountability across the organization. • Ensure meeting of key performance indicators (KPIs), track incident trends, and provide regular reports.

United States
$172K - $232K / year
Job Closed
OtherRemoteTeam 85Since 1981

JMW is a transformation consultancy that empowers leaders to shape the future of their organizations. For 40 years, top executives have trusted us to deliver extraordinary results. Our clients are visionary leaders who recognize that people—how they’re led and engaged—determine organizational success. We partner with businesses to: Diagnose critical leadership and performance challenges Design tailored transformation solutions Empower teams to transform while building leadership skills in real time JMW aligns with our clients’, employees’, and partners’ aspirations by championing the shift from shareholder profit to human-centered value creation . The Opportunity JMW is building a talent pipeline for future openings. Note: This is not an IT or technology consulting role—please apply only if your expertise aligns with the qualifications below. Key Responsibilities: Advise and coach C-suite executives and senior leaders Facilitate large-scale workshops (25+ participants) Manage transformation engagements valued at $750K+ Bridge strategy and execution in people-centered initiatives Deliver measurable impact through organizational and cultural change Required Skills: Strong business and commercial acumen Background in management consulting (industry specialization a plus) Ability to navigate matrixed, complex enterprises Established C-level credibility and presence Project and program management mastery Experience sustaining long-term client partnerships Ability to transform thinking, culture, and behavior Strategic relationship-building and stakeholder influence Entrepreneurial mindset with strong collaboration Proven success facilitating large-group sessions Commitment to lifelong learning and continuous improvement Excellent analytical, communication, and presentation skills Willingness to travel (frequency flexible) Why JMW? We attract professionals who share our core values: Impact | Collaboration | Purpose-Driven | Workability Our team views JMW as: ✓ A platform for professional purpose ✓ An accelerator for leadership impact ✓ A catalyst for personal growth We Provide: Purpose-driven work with premier global clients Competitive compensation, benefits, and performance bonuses Exposure to diverse, high-impact transformation projects A culture that supports authenticity, excellence, and continuous growth JMW is proud to be an equal opportunity employer . We celebrate diversity and welcome all qualified applicants regardless of background, identity, or circumstance. Requirements: Legal authorization to work in the United States Bachelor’s degree required ; postgraduate qualification preferred Full-time, fixed-term position Learn more: www.jmw.com No agency submissions

United States
Job Closed
OtherRemoteTeam 10,001+Since 1855H1B Sponsor

• The Governance & Control Specialist - Centralized 1B Risk Trending & Reporting will report to the 1B Centralized G&C Risk Identification & Aggregation team. • The individual will support the overall process of the creation of the Risk Profiles and reporting. • In addition, the G&C Specialist - Centralized 1B Risk Trending & Reporting will review and analyze key data sources across Major Risk Categories to assist with identification of risk trends, emerging risks and control gaps across business units and legal entities. • The role contributes to the preparation of risk profile related materials and supports routine monitoring activities.

New Jersey + 1 moreAll locations: New Jersey | Michigan
$91K - $136.2K / year
Job Closed
OtherRemoteTeam 10,001+Since 1855H1B Sponsor

• Support the 1B Centralized G&C Risk Identification & Aggregation team in overall process and maintenance of Risk Profiles and reporting • Assist with the review and analysis of key data sources across Major Risk Categories to identify risk trends, emerging risks, and control gaps • Provide essential governance and administrative support, including updating procedures, maintaining process maps, organizing documentation, tracking changes, and assisting with report preparation and coordination activities

New Jersey + 1 moreAll locations: New Jersey | Michigan
$72.3K - $108.2K / year
Job Closed