AVP, Integrated Care Management Operations; Managed Care & DUALS​/FIDE

Job Summary

The Associate Vice President, Integrated Care Management Operations - MA collaborates closely with both Market and Corporate Leadership to ensure the effective delivery of integrated care services across multiple high-volume membership markets and/or markets serving complex populations. This role is instrumental in aligning local service operations with organizational goals, enhancing care quality, improving member outcomes, advancing health equity, and ensuring compliance with state, federal, and accreditation requirements.

The Associate Vice President, Integrated Care provides strategic leadership, operational oversight, and program direction for integrated care and care management activities across assigned regions. In partnership with Market Leadership, Medical Directors, Quality, Analytics, and other key stakeholders, this leader develops and implements innovative, evidence-based programs, standardized operating models, and scalable processes that support exceptional member experiences, quality outcomes, regulatory compliance, and financial performance.

The role also fosters strong relationships with community organizations, healthcare providers, and external partners while supporting growth initiatives, new business implementation, and continuous improvement efforts.

Accountable for collaborating with Market and Corporate Leadership to support the strategy and operations of dual product care management within multiple high-volume and/or complex population markets and to ensure alignment with organizational business programs, priorities, and processes. Provide strategic direction, leadership, and oversight for integrated care activities across the continuum of care, ensuring effective coordination and management of member needs. Ensure programs, operational processes, and care management models within regional markets are appropriately developed, standardized, scalable, and aligned with the corporate Integrated Care framework.

Lead the development, implementation, and evaluation of integrated care programs, innovations, and evidence-based practices designed to improve member outcomes, member experience, quality performance, and operational effectiveness. Establish strategic, operational, and financial plans that optimize the effectiveness and efficiency of integrated care operations while supporting organizational growth and market-specific needs. Assign appropriate priorities according to organizational goals, business plans, regulatory requirements, and market performance objectives.

Lead, implement, develop, and support programs, systems, technologies, and processes that ensure consistent, effective, and efficient delivery of integrated care services while meeting state regulations and market financial objectives. Partner with Market Leadership, Quality, Analytics, Medical Affairs, and other operational leaders to develop performance targets, evaluate outcomes, identify trends, and implement timely corrective actions. Review financial, utilization, quality, service, and operational reports to identify opportunities, analyze trends, and drive data-informed decisions that improve performance and member outcomes.

Develop, maintain, and continuously refine integrated care staffing models, resource allocation strategies, and organizational structures to support market variability, operational efficiency, and sustainable growth. Support the standardization of integrated care processes, workflows, operational content, and best practices to improve consistency, scalability, and continuous process improvement across markets. Collaborate with organizational leaders to ensure successful integration of innovation, technology, and data-driven solutions that enhance member support, address social determinants of health, and advance health equity initiatives.

Monitor continuous quality improvement activities and program effectiveness in accordance with regulatory requirements, URAC, NCQA, HEDIS, accreditation standards, and evolving business needs. Develop, implement, and monitor accountability systems, leadership development initiatives, succession planning strategies, and performance improvement frameworks that support organizational excellence. Foster strong external and internal relationships with hospitals, physicians, behavioral health providers, community-based organizations, government agencies, vendors, and other key stakeholders.

Develop, manage, and oversee departmental and program…