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AVP, Care Anywhere – High Risk Case Management
Location
United States
Posted
131 days ago
Salary
$198.2K - $297.3K / year
Seniority
Lead
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
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