VP of Clinical Operations - (New York, NY)

This position directs the utilization management and care management operations for the all Health Plan programs. This position provides clinical oversight and consultation to the Plan’s Quality Management Program. This position coordinates with the VP of Clinical Risk; and ensures that Value Based Payment arrangements are appropriately administered. Ensures that clinical services are provided in accordance with contracts, regulatory requirements, professional and evidence based standards, as well as with organizational policies and procedures. · Strategically designs programs for clinical service delivery, quality improvement, and monitoring through cross-functional collaboration · Provides oversight and management of the Utilization Management function. · Provides oversight and direction of Pharmacy Services as performed by the Plan’s Pharmacists. · Provides support and guidance to the Quality Management Department in support of achieving quality targets.