Job Description

The VP, Clinical Operations, is responsible for executive oversight of all clinical programs, including Behavioral Health and Employee Assistance Program (EAP) services. This role establishes the strategic direction, operational standards, and quality framework for clinical service delivery across the organization.

The VP, Clinical Operations provides direct leadership to the Behavioral Health Clinical Operations and EAP Clinical Operations team, ensuring alignment, integration, and consistency across all clinical functions, programs, and services.

Preference give to applicants in Northern California.

Essential Duties and Responsibilities:

Provide direct leadership and supervision to AVP-level clinical leaders, ensuring accountability, performance management, and cross-functional alignment across:

• Behavioral Health program operations, including utilization management, provider network management, and clinical program delivery.
• EAP clinical services, including clinical call center operations, case management, crisis response, and employer-based programs.
• Develop and maintain enterprise-wide clinical strategies, policies, and procedures that support high-quality, consistent, and compliant care delivery across all programs.
• Ensure the development and ongoing oversight of:
  • Utilization management programs based on established clinical criteria and guidelines
  • Clinical call center operations and case management functions to support member needs
• Allocate and manage clinical caseloads across clinical teams; cross train teams and document policies and procedures; develop clinical KPIs and manage team performance
• Ensure ongoing compliance with all established policies, protocols, and regulatory requirements, including participation in audits, accreditation processes, and committee oversight (e.g., Quality Management Committee, Public Policy Committees).
• Establish and lead quality improvement initiatives to improve clinical outcomes, patient safety, and service delivery performance.
• Oversee grievance and complaint management processes, ensuring timely investigation, resolution, and reporting of quality of care and service concerns.
• Drive clinical program integration across Behavioral Health and EAP services to ensure a seamless continuum of care and consistent member experience.
• Support provider network expansion and development to enhance access to care and meet membership needs.
• Deliver crisis counseling support as appropriate to clients and/or members.
• Develop and regularly deliver executive-level reporting on clinical operations, program performance, utilization trends, clinical outcomes, and quality metrics.
• Provide quality assurance oversight to client clinical reporting, including data accuracy reviews, requirement definition, outcomes analysis.
• Support organizational growth initiatives, including client engagement, proposal development, and participation in RFP processes.
• Provide clinical leadership in cross-functional collaboration with Operations, Compliance, and Account Management teams.
• Must be willing to travel to the San Francisco Bay Area approximately 15% of the time.
• Perform other responsibilities as assigned.

Essential Education and Experience:

• Minimum 7 years of progressive clinical leadership experience
• 10+ years of healthcare operations, managed care, or business management experience
• Significant experience overseeing behavioral health and/or EAP programs
• Experience managing small to mid-sized clinical teams, including leadership-level direct reports
• Demonstrated experience in utilization management, case management, and clinical program oversight
• Proven track record of driving quality improvement, patient safety initiatives, and operational excellence
• Strong technical aptitude and skills with experience using relevant software and platforms
• Experience with various software programs including Microsoft Suite, Salesforce, and project management tools

Preferred Qualifications

• Knowledge of regulatory and accreditation standards including URAC, NCQA, CMS, DMHC, and Knox Keene
• Experience supporting audits, compliance programs, and accreditation processes
• CEAP or SAP certification preferred

Working Environment

While performing the duties of this job, the employee regularly works in a home remote office near office equipment (telephone, computer). Verbal and written communication, telephone usage, filing, sitting, typing, reading, and carrying are required to perform the essential functions of this job.

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Uprise Health is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.