Vice President, Population Health Management

Overview

This is a hybrid position in Huntington Beach, CA. Candidate must reside in Los Angeles, Orange County or surrounding areas.

Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California's fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth.

Who Are We? Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members' culture and values.

Why Join Us? We re on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you ll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation.

The Vice President of Population Health Management (PHM) provides enterprise-wide leadership for strategies that integrate utilization management, care management, and population health initiatives to improve quality, affordability, and member health outcomes. This role drives clinical and operational performance through data-driven interventions, regulatory compliance, and value-based partnerships, while incorporating Social Determinants of Health and health equity considerations into population health strategies and leveraging analytics for predictive modeling and risk stratification.

• Population Health Strategy & Executive Clinical Partnership:
  Leads the development and execution of the enterprise Population Health Management (PHM) strategy in close partnership with the Health Plan Chief Medical Officer, aligning utilization management, care management, quality, and population health priorities to improve outcomes, affordability, and regulatory performance.
• Clinical Performance, Quality & Population Health Outcomes:
  Provides executive oversight of clinical performance across population health programs, including the development and oversight of disease management initiatives, ensuring evidence-based care models, quality outcomes, and regulatory performance, including Medicare Advantage quality measures such as Stars, HEDIS, and CAHPS, are embedded into program design, execution, and ongoing performance monitoring.
• Provider, IPA & MSO Partnership Governance:
  In partnership with the Health Plan Chief Medical Officer, leads joint operational governance with IPAs and MSOs, including oversight of utilization management and care management functions, performance reporting, and accountability for agreed-upon clinical, quality, and cost outcomes.
• Data, Analytics & Risk Stratification Enablement:
  Provides strategic direction for the use of analytics, predictive modeling, and risk stratification to inform population health interventions, guide resource allocation, and enable data-driven decision-making across utilization management, care management, and quality initiatives.
• Operational Leadership, Team Development & Vendor Oversight:
  Provides strategic guidance, direction, and overall leadership of utilization management and care management teams and processes in support of the enterprise population health strategy; leads and mentors teams, builds workforce and succession plans for critical roles, and oversees population health vendors and platforms to ensure performance accountability, operational readiness, and regulatory compliance.

• 10+ years of progressive leadership experience in population health management, clinical operations, medical management, care management, and/or value-based care within a health plan, managed care, or comparable healthcare environment. Demonstrated executive-level leadership experience with accountability for strategy, clinical performance, operational outcomes, and cross-functional collaboration. Bachelor s degree in healthcare administration, business administration, nursing, public health, social work, or a related field preferred;
  
  or an equivalent combination of education and significant,…