VP, Clinical Operations (Medicare Duals) - REMOTE Location: USA Remote Full-time JOB DESCRIPTION Provides executive level strategy and leadership for teams responsible for optimization of clinical operations across the enterprise. Develops and implements processes to ensure healthcare services functions including utilization management/care management/etc. and clinical vendors provide services in alignment with state, federal, regulatory and Molina quality and compliance standards. Partners with executive leadership team to provide cohesive direction towards company goals. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Supports executive strategy development, vision and direction for enterprise clinical operations. Demonstrates accountability for performance and financial results, and keeps executive leadership apprised. • Leads, manages and implements effective standards, protocols, processes, decision support systems, reporting and benchmarks that support ongoing improvements of clinical operations functions. • Develops initiatives to achieve budgeted reductions in medical expenses and increases in quality scores. • Demonstrates positive leadership role in key clinical management initiatives and analytical studies aimed at optimizing utilization of clinical resources and maximizing operational efficiencies. • Engages with provider community via network teams to identify tangible opportunities for improvement of member outcomes. • Oversees and ensures compliance with contractual, accreditation and regulatory requirements relative to clinical operations. • Responsible for oversight of healthcare services related to delegation oversight monitoring. • Oversees and directs the rendering of clinical decisions at all levels of the health plan that maximize benefits for members while pursuing and supporting enterprise objectives. • Coordinates clinical activities with enterprise vendors and state health plans. • Coordinates the results of audits to improve team performance. • Assists in the development of product-specific policies. • Collaborates with contracting/network to standardize contracts for quality and utilization. Required Qualifications • At least 12 years of managed care experience, including progressive clinical operations experience in a highly matrixed organization, or equivalent combination of relevant education and experience. • At least 7 years of health care management/leadership experience. • Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice. • Strong operational and process improvement experience. • Strong, visible leadership capabilities, and ability to initiate and maintain cross-team relationships. • Understanding of the managed care industry and market conditions. • Strong interpersonal skills. • Strong analytical and problem-solving skills. • Strong organizational and time-management skills. • Ability to work in a cross-functional, highly matrixed environment. • Experience working within applicable state, federal, and third-party regulations.  •Excellent verbal and written communication skills.  •Microsoft Office suite/applicable software program(s) proficiency - Excel, PowerPoint.  Preferred Qualifications • Registered Nurse (RN). License must be active and unrestricted in state of practice. • Certified Professional Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), or other health care or management certification. - Experience with Power BI or Tableau dashboards. - Expertise with Medicare Duals plans. Pay Range: $161,914.25 - $290,732.79 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Job Type  Full Time

• responsible for the end-to-end planning, implementation, and oversight of electronic Clinical Outcome Assessment (eCOA) solutions across assigned clinical trials • serves as the primary point of accountability for eCOA delivery, ensuring systems are configured, validated, deployed, and maintained • partners closely with Clinical Operations, Data Management, Biostatistics, vendors, and sponsors to deliver high quality, patient centric electronic assessment solutions • leads eCOA delivery activities from startup through clos-out, including requirements gathering, system build, UAT script writing, UAT conduct, ongoing maintenance, etc • collaborates with internal stakeholders and sponsor

• Manage staff, providing coaching, mentorship and work direction. • Conduct regular performance appraisals and career discussions with staff. • Facilitates employee career development. • Interviews, recruits and selects staff. • Manages and conducts induction/orientation programs for all new employees, ensuring their smooth assimilation into the company. • Ensures all staff CVs, training records, position profiles and experience profiles are complete and up-to-date. • Supports allocation activities per the local resourcing process. • Supports activities of project leads/functional leads to optimize the operational running of projects. • Delivers training on Working Practice Documents (WPDs) and Standard Operating Procedures (SOPs), local requirements and any other subjects that impact on clinical operations. • Identifies training gaps and ensures that training requirements are met. • Assures adherence to good ethical and regulatory standards. • Alerts management to quality issues, request QA audits as appropriate, and facilitate client and internal quality assurance audits as required. • Collaborates with clinical operations senior management and executive staff on strategic planning and business development as required. • May lead or contribute to initiatives that enhance the department's performance or lead to process improvement across the company.

Role Description This is a remote position. The Workforce Group, a LEMOINE company, is seeking a detail-oriented Case Research & Coordination Lead to support a nationwide federal human services program serving vulnerable populations, including youth, young adults, and families. This role leads: - Address research - Address verification - Case coordination function - Case intake oversight - Location research - Case queue management - Field assignment coordination - Documentation tracking - Follow-up support The Case Research & Coordination Lead is accountable for the quality and timeliness of the team's work. Address determinations must meet the standard of confidence-scored, documentable, and defensible findings. This position requires strong research skills, accurate documentation, sound judgment, confidentiality, and the ability to manage multiple case actions in a fast-paced, deadline-driven environment. Qualifications - High school diploma or equivalent required. - Minimum three years of experience in records research, address validation, case coordination, dispatch, scheduling, records review, human services support, field operations support, including at least one year in a lead, supervisory, or senior coordination capacity. - Experience leading or supporting field-based operations teams or geographically dispersed programs is highly preferred. - Experience supporting vulnerable populations, youth, young adults, families or culturally diverse communities. - Strong attention to detail and ability to review information for accuracy, completeness, and consistency. - Strong documentation and communication skills; ability to prepare and review objective and accurate records. - Demonstrated ability to lead, train, and direct a team toward accuracy and timeliness standards. - Ability to lead and manage multiple cases, deadlines, priorities, and follow-up actions simultaneously. - Strong verbal and written communication skills. - Ability to maintain confidentiality, professional boundaries, and ethical standards at all times. - Ability to work independently and exercise sound judgment in a fast-paced operational environment. - Ability to learn and use approved case management, mapping, routing, research, or documentation tools. - Ability to complete required federal, client, and company training prior to assignment. - Ability to pass and maintain a government security background investigation, including a favorable credit check. - Proficiency using Microsoft Office, email, spreadsheets, shared trackers, databases, and electronic documentation systems. - Must pass a drug test, motor vehicle record check, and background check after accepting a conditional offer. - Bilingual fluency in English and Spanish is strongly preferred. - Training or experience in trauma-informed care, de-escalation, crisis response, mandated reporting, safety planning, or similar practices is strongly preferred. - Must be authorized to work in the United States. - U.S. Citizenship is required for this position due to significant PII/SPII and Government case-data access. Requirements - Lead daily operations of the address research, address verification, and case coordination function, setting work queue priorities and balancing workload across analysts and coordinators. - Oversee address development, redevelopment, and verification to ensure determinations are made using approved tools, records, databases, and that each is supported by documented research steps, source rationale, and confidence scoring. - Review and approve case determinations, escalations, and rework; serve as the escalation point for complex, conflicting, or high-priority cases. - Coordinate movement of cases through research, field assignment, quality review, data entry, language access, and reporting stages. - Direct case routing to field teams based on geography, urgency, language needs, revisit probability, travel considerations, and operational capacity. - Own monitoring of case milestones and 10-calendar-day timeliness deadlines; identify at-risk cases early and drive corrective action. - Supervise, train, and develop Address Research/Location Analysts and case coordination staff. - Monitor individual and team performance against accuracy and timeliness standards. - Direct redeployment and follow-up activity when a participant is not located, and address changes, or additional information is needed. - Maintain accurate case coordination documentation, communication logs, assignment records, and status reporting in approved systems, trackers, forms, or databases. - Identify potential documentation gaps, conflicting information, duplicate records, or incomplete case information and implement corrective measures. - Partner with program leadership, field operations, quality review, language access, and data/reporting functions to support timely, accurate case progression. - Protect sensitive participant, program, and Government-related information. - Maintain professional, objective, and accurate documentation without unsupported conclusions or personal opinions. - Participate in required training, operational briefings, quality assurance activities, and staff meetings. - Perform additional duties as assigned. Benefits - Employment is contingent upon successful completion of all pre-employment screening requirements, including background checks, drug screening, motor vehicle records review, reference checks, and other job-related screening requirements. - Employment is also contingent upon successful completion of required federal background/suitability review, favorable credit check, security processing, and program-specific onboarding before beginning work. - Employees assigned to this program must complete required training, protect sensitive information, comply with standards of conduct, maintain professional boundaries, and follow all reporting, confidentiality, privacy, and information security requirements. - Employees may be required to sign confidentiality, non-disclosure, conflict-of-interest, and standards-of-conduct acknowledgments.