VP of Clinical Innovation

VP of Clinical Innovation

Who we Are

As a leading healthcare intelligence company with over 40 years of experience, we put our unrivaled payment integrity, subrogation, and coordination of benefits (COB) expertise, expansive perspective, and relentless focus to work for our clients—ensuring no stone is left unturned in our pursuit of unmatched results. Our commitment to accuracy and excellence has helped us grow into a proven leader of our industry, relied on by companies large and small to help them maximize their return on investment.

Location: This role is full remote

About the Opportunity

At NewCo, we’re constantly reimagining what’s possible in our industry—creating disruptively simple, powerfully clear ways to maximize our clients’ financial outcomes today and drive down healthcare costs tomorrow. As part of the Complex Payment Solutions team, you will be an experienced and visionary Vice President of Clinical Innovation to lead the transformation of complex payment solutions through the strategic use of artificial intelligence (AI), cutting-edge technologies, and a deep understanding of clinical billing and payment. This senior leadership role will be responsible for pioneering new approaches to clinical payment data analysis, enhancing the accuracy, efficiency, and overall quality of complex payment reviews within our organization. The VP will collaborate with cross-functional teams to integrate solutions into payment workflows, ensuring better decision-making and improved financial outcomes. This position will also play a key role in new content development, building strong, long-term relationships with customers, and applying clinical and coding knowledge to enhance payment review processes.

What you’ll do

• Strategic Leadership: Lead the development and execution of the clinical innovation strategy, focusing on leveraging advanced technologies to transform complex payment review processes. Align initiatives with organizational goals to drive meaningful change in healthcare payment operations.
• AI and Technology Integration: Identify and implement AI-driven solutions to enhance the accuracy and efficiency of complex payment reviews, ensuring compliance with healthcare financial standards and regulations. Partner with technology teams to develop and deploy cutting-edge models that improve payment workflows.
• Innovation and Research: Stay ahead of industry trends, emerging technologies, and regulatory changes in healthcare. Foster a culture of innovation by continuously exploring new processes and technologies that can positively impact payment review processes and financial operations.
• New Content Development: Lead efforts in developing new content, resources, and tools to support and improve complex payment review processes. Ensure that content aligns with the latest regulatory changes, industry best practices, and clinical coding standards.
• Building Customer Relationships: Build and nurture strong relationships with customers, including healthcare providers, payers, and other stakeholders. Work closely with clients to understand their needs and challenges, ensuring the delivery of high-value solutions that enhance their payment review processes and improve financial outcomes.
• Clinical and Coding Knowledge: Leverage a deep understanding of clinical practices and coding systems (e.g., ICD-10, CPT, HCPCS) to enhance the accuracy and efficiency of complex payment reviews. Ensure that payment review processes align with current clinical standards and coding regulations to prevent errors and ensure compliance.
• Data-driven Decision Making: Utilize data analytics to monitor and measure the effectiveness of solutions, ensuring continuous improvement. Develop metrics and KPIs to assess the success of clinical innovation initiatives.
• Quality and Compliance: Ensure that innovations in complex payment reviews adhere to all regulatory, ethical, and financial quality standards. Work with legal, compliance, and risk management teams to mitigate any potential risks associated with new technologies.
• External Partnerships and Thought Leadership: Represent the organization in external forums, industry conferences, and thought leadership opportunities. Develop and maintain relationships with key partners, vendors, and academic institutions to advance complex payment review innovation initiatives.

What experience you bring (Role Requirements)

• Proven experience (10+ years) in clinical leadership roles, with at least 5 years in senior payment integrity positions.
• Expertise in the application of AI, machine learning, and automation technologies within healthcare financial operations, particularly in complex payment review processes.
• Deep understanding of payment review workflows, healthcare payment systems, clinical practices, and coding systems (e.g., ICD-10, CPT, HCPCS).
• Strong track record of leading successful innovation projects, especially those that integrate AI and technology into payment review processes.
• Experience in developing new content and resources to support business objectives and drive client success.
• Proven ability to build and maintain strong customer relationships, with a focus on understanding client needs and delivering impactful solutions.
• Ability to think strategically and lead cross-functional teams in a complex, fast-paced environment.
• Excellent communication and interpersonal skills, with the ability to engage and influence stakeholders at all levels of the organization.
• Nursing degree or advanced clinical degree is highly preferred.

What Success Looks Like…

After 3 months

• You will have a strong understanding of the role.
• You begin building relationships and collaborating with peers.
• You develop effective time and priorities management.
• You receive initial feedback about your performance and are using it to improve.
• You’ve gained confidence in your abilities and are starting to feel more comfortable in your role.

After 1 year

• You have mastered the tasks and responsibilities of the position, executing them with confidence and efficiency.
• You have established a strong network of internal relationships and are recognized as a key collaborator.
• You’ve been entrusted with greater responsibility indicating the company’s confidence in your abilities.
• You see opportunities for career progression and personal development.

Pay range: $200,000-$260,000 USD

This is an exempt position.  The salary range is for Base Salary. Compensation will be determined based on several factors including, but not limited to, skill set, years of experience, and the employee’s geographic location.

What’s in it for you                                                                                                   

• PTO, Paid Holidays, and Volunteer Days
• Eligibility for health, vision and dental coverage, 401(k) plan participation with company match, and flexible spending accounts
• Tuition Reimbursement
• Eligibility for company-paid benefits including life insurance, short-term disability, and parental leave.
• Remote and hybrid work options

At NewCo, we’re reimagining a simpler way forward. This begins with our employees. We are innovators who value integrity, teamwork, accuracy, and flexibility. We do the right thing, and we listen to the needs of our clients and their members. As tenured experts with unmatched experience, we champion diverse perspectives that help us to better understand and serve our clients.

Our values come to life through our culture. We embrace flexible working arrangements that allow our employees to bring innovation to life in the way that best suits their productivity. We work cross-functionally, abandoning silos, to bring innovative, accurate solutions to market. We invest in each other through ongoing education and team celebrations, and we give back to our communities through dedicating days for volunteering. Together, NewCo is making healthcare work better for everyone, and we’re passionate about a future with better outcomes for all.

We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace. NewCo is an employment at will employer.

#LI-VPM

#INDHP