AVP, Utilization and Care Management Strategy

Become a part of our caring community The AVP, Utilization and Care Management Strategy provides enterprise strategic leadership for Medicaid utilization management, care management, clinical policy governance, affordability initiatives, medical expense strategy, and performance oversight. Reporting to the VP, Medicaid Clinical Strategy and Affordability, this role leads the development and execution of a coordinated strategy designed to improve total cost of care, appropriate member access, care coordination, provider experience, quality outcomes, regulatory alignment, and program stewardship. This is a strategy, governance, and cross-functional leadership role. The AVP is not expected to directly manage day-to-day utilization management or care management operations but will partner closely with operational leaders to shape priorities, establish strategic direction, define performance expectations, evaluate outcomes, and support scalable execution across Medicaid markets. This leader is accountable for integrating utilization and care management strategy into a cohesive enterprise approach that supports the right care, at the right time, in the right setting, for Medicaid members. The role connects insights from authorization activity, utilization patterns, claims, denials and appeals, care management engagement, care gaps, admissions, emergency department use, post-acute utilization, high-risk member needs, and provider practice variation to inform enterprise strategy and