Job Description

At Blue Zones Health we are redefining what it means to live a vibrant and healthy lifestyle. Inspired by long-living cultures around the world, we strive to empower people to make simple and sustainable lifestyle changes that lead to longer, better and more fulfilling lives. If you are ready to help transform well-being and be a pivotal part of our team, we want to meet with you!

Position Summary

The Vice President of Clinical Operations will oversee risk adjustment, coding integrity, and quality improvement programs for Blue Zones Health . This role is responsible for leading strategy and execution of clinical quality and risk adjustment initiatives across multiple health plan partnerships, with direct oversight of annual wellness visits, coding and documentation accuracy, HEDIS and STARs quality performance, vendor relationships, reconciliations, and operational excellence. The VP will manage a multidisciplinary team to ensure optimal clinical and financial performance while maintaining compliance with state and federal regulations.

Key Responsibilities

Risk Adjustment & Coding Oversight

• Provide strategic leadership and oversight of risk adjustment programs across all business lines to optimize revenue integrity and accuracy of coding.
• Oversee provider coding education, chart reviews, and audit programs to ensure accurate and compliant documentation.
• Own relationships with external coding vendors and internal clinical documentation teams.
• Manage reconciliation and reporting processes to identify gaps and ensure completeness of encounter submissions.

Quality Program Management

• Direct the design, implementation, and monitoring of quality initiatives including HEDIS, STARs, and other plan-specific programs.
• Oversee annual wellness visit (AWV) programs, including outreach, scheduling, completion, and documentation.
• Ensure performance against quality benchmarks established by contracted health plans and regulatory bodies.
• Collaborate with provider networks to drive improved clinical outcomes and member experience.

Operational Leadership

• Establish KPIs, dashboards, and reporting mechanisms to track progress and drive accountability.
• Oversee vendor selection, contracting, and performance management.
• Partner with Compliance, Finance, and Clinical leadership to align operations with organizational goals and regulatory requirements.

Regulatory & Compliance

• Ensure programs comply with Knox-Keene Act requirements, CMS guidelines, DHCS standards, NCQA/HEDIS protocols, and others as identified
• Implement internal audit and monitoring processes to safeguard against compliance risks.
• Serve as a subject matter expert on coding, risk adjustment, and quality standards.

Qualifications

• Bachelor’s degree in Nursing, Health Administration, Public Health, or related field required; Master’s degree preferred.
• Current RN, CPC, CRC, or other relevant certification strongly preferred.
• Minimum 10 years of progressive leadership experience in clinical operations, risk adjustment, and quality improvement within a managed care or IPA/medical group environment.
• Deep knowledge of Knox-Keene regulatory requirements and Medicare Advantage/Medi-Cal risk adjustment and quality programs.
• Proven track record of managing large teams and third-party vendors.
• Strong analytical, financial acumen, and program management skills.
• Excellent communication and relationship-building abilities with providers, payors, and internal stakeholders.

Work Environment & Physical Requirements

• Standard office environment; hybrid options may be available.
• Prolonged periods of sitting at a desk and working on a computer.
• Occasional lifting of files, records, and documents up to 10 pounds.
• Travel as needed

Compensation & Benefits

Blue Zones Health offers a competitive salary and benefits package, including health, dental, and vision insurance, retirement plan options, paid time off, and opportunities for professional growth and development.

The compensation range for this position is $140,000 - $160,000 depending on experience.

For more information about Blue Zones Health , check us out at

Blue Zones Health does not discriminate on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity or expression, age, disability, veteran status, or any other protected status under applicable law.

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