Remote Clinical Program and Population Health Strategist-Government Programs

Location Address:

Compensation Pay Range:

Summary:

Responsibilities:

The Clinical Program & Population Health Strategist - Government Programs is responsible for advancing population health strategy for ACA, Medicaid, and Dual Eligible Special Needs Plan (D-SNP) populations. This role aligns with Presbyterian's integrated delivery system (IDS) model and Health Value strategy, partnering across the health plan, medical group, and care delivery system.

The Strategist translates enterprise population health priorities into product-specific strategies, clinical program designs, and a prioritized Clinical Initiative Portfolio. This role influences execution through cross-functional partnerships but does not directly manage program operations or vendor performance.

Some key responsibilities include:

Government Programs Population Health Strategy

• Develop population health strategies for ACA, Medicaid, and D-SNP populations aligned with enterprise priorities
• Identify high-impact opportunities to improve outcomes for complex and vulnerable populations
• Ensure alignment with regulatory requirements and product-specific goals

• Clinical Initiative Portfolio Strategy & Prioritization
• Support development and refinement of the Clinical Initiative Portfolio
• Partner with product owners and leadership to prioritize initiatives based on impact and ROI
• Define success metrics aligned with HEDIS, Stars, risk adjustment, and utilization goals

• Clinical Program Design & Strategic Guidance
• Design evidence-based clinical programs and interventions
• Define target populations, program goals, and success measures
• Partner with program and operational leaders to support implementation and scaling
• Inform build vs. buy decisions for clinical capabilities

• Provider Strategy & Performance Enablement
• Translate clinical strategies into provider-facing approaches
• Support development of provider tools, workflows, and reporting
• Provide input into value-based care models and provider performance strategies

• Product & Cross-Functional Alignment
• Serve as liaison to Government Programs teams
• Ensure alignment between benefit design, clinical programs, and population health outcomes
• Collaborate with analytics, network, and operations teams

• Analytics & Insights
• Partner with analytics teams to define measurement frameworks
• Use data to identify trends, gaps, and opportunities
• Translate insights into actionable recommendations

• Regulatory & Compliance Strategy
• Ensure strategies align with CMS and Medicaid requirements
• Support audits, reporting, and program integrity efforts

• Health Equity & Community Integration
• Embed health equity into all strategies and program designs
• Identify disparities and recommend targeted interventions
• Partner with community organizations and internal teams
• Medicare Stars and HEDIS performance
• Medicaid quality measures
• Gap closure and preventive care utilization
• Total cost of care and utilization trends
• Clinical Initiative Portfolio performance and ROI
• Health equity outcome measures
• Reports to:
  
  Vice President, Population Health, Provider Strategy and Performance
• Key partnerships:
  Government Programs Product Owners, Provider Strategy, Analytics, Network Management, Compliance, Community Health
• Collaborates across Presbyterian Health Plan and Medical Group

Qualifications:

• Bachelor's degree required;
  Master's degree (MPH, MHA, MBA, or…