California Licensed Clinical Performance AVP

Job Summary

A company is looking for an AVP of Clinical Performance.

Key Responsibilities

• Oversee strategy, operations, and performance of Delegated Utilization Management (UM) and Care Management (CM) programs
• Lead UM programs including prior authorization and medical necessity determinations, ensuring compliance with relevant requirements
• Manage inpatient and complex care management programs, establishing standardized workflows and documentation practices

Required Qualifications, Training, and Education

• Bachelor's Degree in business, healthcare administration, nursing, or a related field is required; MBA/MHA and/or clinical degree is preferred
• Minimum of ten (10) years of MSO operations experience, with at least five (5) years in a national/regional management role
• Experience in change management and process improvement is required
• Registered Nurse license is preferred