Our Client is a respected and financially strong
insurance carrier with a national presence. You would have an opportunity to be
part of the expansion of this division if you were selected to join the
leadership team. Making a difference in healthcare is what we they do,
are you ready to be part of something unique?
Your role would be to lead the development of strategy
and associated initiatives for this division. This includes portfolio strategy,
value proposition, and channel strategy for Medicare, Medicare Advantage, and
other health insurance products.
You will have accountability for providing strategic leadership direction and drive results
that meet the strategic and operating functions within this client.
The Vice President,Operations builds, manages, and maintains vendor relationships and partnerships
that provide strategic value to this Client. You will serve as a key
member of the Leadership team providing strategic expertise and direction on
operations, compliance, and vendor oversight.
You will oversee all operations for the Medicare Advantage LOB; Implements process and product
improvements; Builds strong cross-functional relationships to engage stakeholders and manage initiatives.
You will provide leadership for the day-to-day operations of the selected vendor(s) of the
Medicare Advantage products to support continued growth and ability to meet regulatory and contractual obligations.
This includes monitoring and measuring the qualitative and quantitative improvements achieved
through the project(s) to support realization of benefits, including process improvement outcome analysis, return on investment, issues tracking and
resolution. Especially as it relates to maximizing Star Ratings and other key quality measures of plan performance.
You will provide leadership, direction, CMS expertise, and skill development to the key vendors
for the plan’s quality assurance standards, internal controls, and audit processes for enrollment, premium billing, claims, customer service, benefits materials & configuration, and other operational areas.
You will oversee operational performance and identifies compliance gaps or deficiencies. Prepares and oversees the timely implementation of corrective
action plans, including validation of plans for effectiveness in remediatingareas of noncompliance.
You will develop,align and implement practices to optimize efficiencies, increase scalability,
allow for growth and deliver a positive customer experience for all stakeholders.
Develop strategic,operational, and tactical business plans to achieve desired organizational
short- and long-term goals.
You will lead operational teams to support annual open enrollment and product implementation
(operational readiness) and execution.
Assist with defining product strategy and work closely with teams to create and file Medicare
- Bachelor’s Degree/Masters Preferred
- Ten+ years’ experience in managed care
or physician group operations (senior level)
- Medicare Advantage experience
required, including managing CMS relationship
- In-depth industry knowledge of ACA,
MACRA, MSSP, Population Health, Clinical Integration, Value-Based Payment
- Excellent leadership skills with
proven entrepreneurial approach to solving healthcare problems
- Demonstrated ability to multi-task and
work in a fast-paced environment as a leader of both a growing workforce