The Vice President Clinical Operations is the senior clinical leader overseeing absence, disability, and leave management services. They ensure clinical quality, rigorous medical decisions, and integration of expertise into claims operations. Collaborating with Operations, Sales, and Clients to enhance employee outcomes and drive business growth.
Responsibilities
Acting as the lead clinical expert for leave and disability case management, ensuring accurate claim decisions and effective return-to-work plans.
Providing expert clinical consultation on complex, high risk, or escalated
Overseeing clinical quality programs, including audits, peer reviews, nurse over reads, and retrospective reviews to ensure consistency and best practices.
Leading and facilitating regular clinical roundtables to guide case strategy, functional capacity assessment, and care planning.
Managing and evaluating physician consultants and senior clinical staff (RNs). Overseeing recruitment, credentialing, performance, and quality of physician reviewers, IME providers, and peer review vendors. Reviewing peer review productivity, quality, and compensation for appropriateness.
Leading clinical credentialing meetings and ensure adherence to licensure and certification requirements.
Designing and delivering ongoing clinical training for case managers, nurses, and physician consultants. Providing guidance and training for sensitive situations, including threats to self or others.
Overseeing development of clinical content, including LOA guides, disability reference materials, attending physician forms, and onboarding curricula. Leading continuing medical education initiatives and external clinical lecture programs.
Supporting client relationship management through participation in quarterly and annual reviews.
Providing clinical expertise during finalist meetings, RFPs, and sales presentations.
Developing and presenting materials that articulate the clinical model, peer review approach, and value proposition. Performing targeted clinical data analysis to help clients understand trends, outcomes, and opportunities for improvement.
Providing clinical input into technology platforms, diagnostic coding, vendor integrations, and clinical thought design. Designing and reviewing reports, metrics, and analytics demonstrating clinical outcomes, ROI, productivity, and quality.
Requirements
Have MD, DO, or equivalent doctoral degree in a healthcare field.
Possess active clinical licensure, board certification.
5+ years of leadership experience in disability, leave, or absence management.
Display compelling communication, presentation, and analytical skills.
Have extensive experience with clinical auditing, quality programs, and interdisciplinary teams.
Demonstrate promoting diversity, collaboration, and a global mindset across clinical teams.
Be a subject matter expert who has served as a trusted advisor to senior leadership on clinical risk, strategy, and performance.
Align with company strategy, policies, and ethics.
Application and Interview
Benefits
Flexible WorkingSo that you can be your best at work and home, we consider flexible working arrangements wherever possible. Alight has been a leader in the flexible workspace and "Top 100 Company for Remote Jobs" 6 years in a row.Great Place to WorkThanks to the work of every colleague, Alight has received multiple awards of recognition including "Great Place to Work" for the past 7 years and Fortune's "Best Companies to Work For." To learn more about our company culture and awards Click Here.If you, Champion People, seek to Grow with Purpose, and embody the meaning of Be Alight - We invite you to join our team! Learn more at careers.alight.com .Health insuranceDental insuranceVision insuranceRemote work optionsFlexible scheduleParental leave
Additional Information
Amazing Opportunity and Great Place to Work!
Our story
At Alight, we believe a company's success starts with its people. At our core, we Champion People, help our colleagues Grow with Purpose and true to our name we encourage colleagues to "Be Alight." We are passionate about connecting purpose with impact. Alight empowers clients to build a healthier and more financially secure workforce by unifying the benefits ecosystem across health, wealth, wellbeing, navigation, and absence management.
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