SVP Clinical Guidance

Company :
Highmark Health Job Description :
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

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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Ensure the guidance system enables more effective and affordable care, leading to measurable improvements in health outcomes, increased upstream preventive care, and