matter-health - SVP, Clinical Quality & Population Health

Remote - Nashville2w ago

Remote Vp NA Healthcare Chief Medical Officer Registered Nurse Team Leadership Coaching Reporting Program Management Close Documentation Clinical Documentation Hedera Governance Performance Management Performance Reviews

Requirements

• This is an opportunity for a leader who is comfortable creating structure where it doesn't yet exist, establishing processes and accountability, building high-performing teams, and personally driving initiatives from strategy through implementation. • Success requires someone who can move seamlessly between executive discussions, payer relationships, board presentations, and the day-to-day operational work necessary to achieve measurable results. • The SVP will serve as a strategic dyad partner to the SVP of Operations, ensuring clinical and operational priorities remain closely aligned. This leader will also partner with the Chief Medical Officer's Clinical Affairs function and represent clinical quality and population health in executive, payer, regulatory, and cross-functional discussions. • This is a highly visible leadership opportunity for an executive who thrives in a growing organization, takes ownership, and isn't afraid to get their hands dirty. • 10+ years of progressive leadership experience in clinical quality, population health, clinical operations, clinical program management, or a related healthcare function. • Experience working in a healthcare startup, personally establishing the teams, processes, and operational infrastructure needed to support growth. • Significant senior leadership experience within a Medicare Advantage organization, value-based healthcare organization, health plan, health system, multisite medical group, or comparable healthcare environment. • Demonstrated experience personally building, launching, scaling, or significantly transforming clinical quality, population health, or clinical operations functions. • Proven ability to operate successfully in a startup, high-growth, rapidly expanding, or transformational healthcare environment where processes and infrastructure must be built or substantially improved. • Direct accountability for Medicare Star Ratings, HEDIS, CAHPS, and clinical quality performance improvement, including demonstrated experience translating strategy into measurable results. • Experience directly leading or owning provider credentialing operations, including process development, operational performance, compliance, and provider onboarding. • Strong understanding of Medicare Advantage, value-based care, and quality performance requirements. • Demonstrated experience leading clinical operations and multidisciplinary teams across complex healthcare environments. • Experience developing, implementing, and scaling clinical quality or population health programs. • Knowledge of clinical documentation improvement, coding accuracy, HCC/RAF, and risk adjustment. • Experience using clinical quality dashboards, claims data, analytics, and operational performance reporting to guide decision-making. • Strong executive presence, communication skills, and the ability to influence C-suite leaders, payers, clinical stakeholders, and cross-functional partners. • Proven ability to establish structure, build teams, create accountability, and drive execution in evolving or resource-constrained environments. • A hands-on leadership approach with a willingness to work directly through operational challenges rather than relying solely on delegation or oversight. • Ability and willingness to travel moderately to Matter Health locations and markets, including Nashville and Memphis. • Master's degree in Healthcare Administration, Public Health, Nursing, Business Administration, or a related field. • Active clinical licensure, such as Registered Nurse, Nurse Practitioner, or an equivalent clinical credential. • Experience supporting Medicare Advantage populations, including dual-eligible or special needs plan populations. • Experience with NCQA or URAC accreditation. • Experience preparing for regulatory surveys, payer reviews, and external audits. • Experience supporting clinical quality and operational functions across multiple geographic markets. • Experience working within home-based care, primary care, geriatrics, or other value-based care delivery models. • Experience serving in a dyad or shared-accountability leadership model. • Demonstrated success presenting clinical quality and operational performance information to boards, executive leadership teams, payers, or regulatory stakeholders. • WHAT SUCCESS LOOKS LIKE • The successful candidate will be a visible, accountable leader who builds the infrastructure, teams, and processes necessary to support Matter Health's continued growth.

Responsibilities

• CLINICAL QUALITY, MEDICARE STARS & HEDIS • Own the development, implementation, and execution of Matter Health's enterprise clinical quality strategy. • Lead Medicare Star Ratings performance improvement initiatives, including HEDIS, CAHPS, and applicable Medicare Part D quality measures. • Establish measurable quality goals, performance dashboards, accountability structures, and continuous improvement processes. • Identify gaps in quality performance and translate clinical, claims, and operational data into actionable improvement strategies. • Develop and execute interventions that improve quality outcomes, close care gaps, and support value-based performance. • Partner with payers, clinical leaders, and operational teams to drive performance against contractual and regulatory quality measures. • Establish scalable quality improvement processes that can be replicated across new and existing markets. • Maintain accountability for measurable results, including quality performance, regulatory readiness, and operational effectiveness. • BUILD & SCALE CLINICAL PROGRAMS • Design, build, implement, and scale clinical and population health programs that support Matter Health's value-based care model. • Develop the processes, workflows, governance structures, and performance expectations needed to support organizational growth. • Translate strategic priorities into practical programs that can be successfully implemented by clinical and operational teams. • Establish consistent clinical standards and evidence-based practices across markets. • Evaluate existing programs, identify opportunities for improvement, and lead initiatives to strengthen effectiveness and scalability. • Partner with clinical leadership to ensure programs are patient-centered, operationally practical, and aligned with quality and population health goals. • Build infrastructure and processes that support rapid market expansion without compromising quality or compliance. • CLINICAL OPERATIONS & EXECUTION • Provide executive leadership and direct operational accountability for clinical quality and clinical program execution. • Partner closely with the SVP of Operations to align clinical strategies with day-to-day care delivery and operational performance. • Identify workflow inefficiencies, operational barriers, and performance gaps, then lead the implementation of practical solutions. • Establish operating rhythms, performance reviews, and accountability measures to ensure consistent execution across teams. • Work directly with clinical, operational, and administrative leaders to resolve challenges and improve performance. • Support the development of scalable clinical workflows that improve efficiency, consistency, and patient outcomes. • Remain actively engaged in execution, particularly when new programs, processes, or teams are being established. • PROVIDER CREDENTIALING & COMPLIANCE • Own the strategy, operational performance, and continuous improvement of Matter Health's provider credentialing function. • Establish and optimize credentialing and recredentialing workflows, processes, systems, and accountability structures. • Ensure credentialing operations support timely provider onboarding, market expansion, and organizational growth. • Oversee compliance with applicable payer, regulatory, and accreditation requirements. • Identify and resolve credentialing bottlenecks, operational inefficiencies, and process gaps. • Partner with clinical leadership, operations, compliance, and other stakeholders to ensure credentialing requirements are met consistently. • Build scalable credentialing processes, reporting mechanisms, and quality controls that support growth across multiple markets. • Maintain executive accountability while remaining closely involved in resolving complex credentialing and operational challenges. • CODING, RISK ADJUSTMENT & DOCUMENTATION • Oversee clinical documentation improvement, coding accuracy, and compliant risk adjustment programs. • Partner with clinical, coding, compliance, and finance teams to strengthen HCC capture, RAF accuracy, and documentation quality. • Establish processes and accountability measures that support accurate, compliant documentation and coding practices. • Identify opportunities to improve clinical documentation workflows and provider education. • Use performance data to identify gaps, monitor outcomes, and support continuous improvement. • Ensure coding and risk adjustment initiatives align with regulatory requirements and value-based care objectives. • EXECUTIVE LEADERSHIP & CROSS-FUNCTIONAL PARTNERSHIP • Serve as a trusted strategic partner to the Chief Medical Officer and executive leadership team. • Build, lead, coach, and develop multidisciplinary teams across clinical quality, clinical programs, and related functions. • Represent Matter Health in executive meetings, payer discussions, board presentations, regulatory interactions, and other high-level engagements. • Translate complex clinical quality and operational performance information into clear, actionable recommendations for senior leadership. • Collaborate across clinical, operations, finance, compliance, technology, and other functions to drive organizational priorities. • Build strong relationships with internal and external stakeholders while maintaining a focus on measurable results. • Lead effectively through ambiguity, competing priorities, and the evolving needs of a high-growth organization. • Foster a culture of accountability, continuous improvement, collaboration, and operational excellence. • Establishing a scalable, enterprise-wide clinical quality and population health strategy with clear priorities and measurable accountability. • Demonstrating meaningful improvement in Medicare Star Ratings, HEDIS, CAHPS, and applicable quality measures. • Building or strengthening clinical programs that deliver measurable improvements in patient outcomes and operational performance. • Creating reliable, scalable provider credentialing processes that support timely onboarding and market expansion. • Strengthening clinical documentation, coding accuracy, and compliant risk adjustment performance. • Developing high-performing teams and clear operating structures that support consistent execution. • Building effective quality dashboards, governance processes, reporting structures, and performance management systems. • Improving alignment and shared accountability between clinical leadership and operations. • Establishing trusted relationships with executives, clinicians, payers, regulators, and other key stakeholders. • Demonstrating the ability to move between strategic leadership and hands-on execution while delivering meaningful organizational results. • This is a remote position with moderate travel to Matter Health locations and markets, including Nashville and Memphis. • Candidates located near Nashville are welcome to work from Matter Health's Nashville office when desired. • Travel requirements will vary based on organizational, leadership, clinical, and operational needs.

Benefits

• At Matter Health, we believe that where someone lives should never determine the quality of healthcare they receive. • Every member of our team plays an important role in expanding access to primary and preventive care for older adults living in affordable housing communities. • This is an opportunity to do more than lead an established function. • 401(k) with company match beginning at Day 60 • Access to financial wellness resources • Up to four weeks of paid time off • 10 paid company holidays • Two volunteer days annually • Benefits and eligibility are subject to applicable plan terms.