Vice President – Clinical Operations

Role Overview

• 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 cases.
• 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.

Benefits

• Health, dental, and vision coverages starting Day One.
• Wellbeing programs.
• Retirement plans with contribution matching.
• Generous time off.
• Parental leave.
• Continuing education.
• Career growth opportunities.
• Flexible working arrangements.