SVP Clinical Guidance

JOB SUMMARY

The SVP Clinical Guidance serves as the senior clinical leader responsible for translating enterprise clinical strategy into the design, development, and execution of the Living Health Guidance System. This role will lead the clinical vision for a next-generation guidance model that proactively supports members, enables providers, and advances more effective, affordable, and evidence-based care.

Working in close partnership with clinical, product, technology, data, analytics, provider, and operational leaders, this executive will ensure clinical intelligence is embedded across digital and physical care experiences. The SVP will guide the development of clinical decision support capabilities, including evidence-based pathways, pharmacy recommendations, longitudinal data insights, and AI-enabled guidance tools that deliver personalized, actionable recommendations for members and providers.

This leader will play a critical role in advancing the organization from traditional health plan administration toward proactive clinical guidance. The SVP will ensure recommendations are grounded in data, clinical evidence, provider workflows, and member needs, while supporting improved outcomes, earlier intervention, greater affordability, and a more seamless healthcare experience.

The ideal candidate is a senior clinical executive with deep experience in clinical strategy, health informatics, digital health solutions, provider engagement, and large-scale transformation within a complex healthcare environment.

ESSENTIAL RESPONSIBILITIES

• Establish and execute the long-term clinical vision and 5+ year strategy for the Living Health Guidance System, leading the organizational shift from reactive administration to proactive, trust-based clinical advocacy.

• Serve as the senior clinical leader on the cross-functional leadership team, defining the strategic priorities and scope for the "Clinical Brain" to ensure alignment with the Enterprise 2030 vision.

• Exercise disciplined fiscal oversight of the clinical guidance engine, defining budget standards, directing investment in "build vs. buy" opportunities, and ensuring all resource allocation is directly tied to delivering improved health outcomes and a clear return on investment.

• Champion the clinical imperative for radical simplicity, ensuring the guidance system is designed to remove administrative friction and make the best health decisions the easiest actions for members to take.

• Spearhead the end-to-end design of the "Clinical Brain," the core intelligence of the Guidance System, by overseeing the development of its clinical decision support logic, AI-driven agents, and advanced data models.

• Ensure all guidance is built on a foundation of genuine, evidence-based clinical direction, creating actionable and authoritative recommendations backed by robust data and pathways.

• Determine the optimal "build vs. buy vs. partner" strategy for all clinical intelligence components, evaluating external solutions to accelerate speed-to-market while retaining proprietary control over key differentiators.

• Lead the seamless integration of clinical intelligence across the entire health journey, collaborating extensively with product, design, engineering, and data teams to embed guidance into all member and provider touchpoints.

• Drive the clinical strategy for provider enablement and alignment, deploying tools, EMR integrations, and innovative incentive models that foster collaboration and reward adherence to optimal care pathways.

• Authoritatively recommend the next best health actions for members and facilitate the seamless sharing of actionable information with their providers to create a connected and collaborative care experience.

• Ensure the guidance system enables more effective and affordable care, leading to measurable improvements in health outcomes, increased upstream preventive care, and a reduction in the total cost of care.

• Influence the generation of significant multi-million dollar savings through the successful clinical leadership and strategic implementation of the Guidance System across the enterprise.

EXPERIENCE

Required

• A minimum of 15 years of progressive leadership experience within a large, complex healthcare organization, such as an integrated delivery and financing system, health plan, or a health technology company.

• Demonstrated track record of success in designing, developing, and implementing large-scale clinical decision support systems and/or digital health solutions.

• Proven experience leading clinical strategy and program development in a multi-stakeholder environment.

Preferred

• None

SKILLS

• Strategic & Visionary Leadership: Ability to translate high-level strategy into a concrete operational vision and execution plan.

• Collaborative Influence: Expertise in leading through influence, working in a matrix environment,  and fostering collaboration across cross-functional teams and executive leadership.

• Health Informatics: Deep understanding of clinical data architecture, interoperability standards, EMR systems (like Epic), and data analytics.

• Clinical Program Design: Proficiency in designing evidence-based scalable clinical programs that drive measurable improvements in health outcomes and affordability.

• Operational Excellence: Strong ability to manage complex projects, drive for results, and navigate the challenges of a large-scale transformation initiative.

• Provider Engagement: A strong understanding of provider workflows and the ability to build systems that support and enable clinicians.

EDUCATION

Required

• An advanced clinical or medical degree (e.g., MD, DO)

Preferred

• A PhD or Master's degree in a relevant field (e.g., Health Informatics, Public Health, Business Administration, Medical Management) combined with extensive clinical experience

LICENSES or CERTIFICATIONS

Required

• Medical Doctor 

Preferred

• Active medical license

Language (Other than English):

• None

Travel Required:

• Less Than 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

• Office-Based or Remote Position

Physical work site required

• Occationally

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

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Pay Range Maximum:

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations.  The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

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