Vice President Medicare/Medicaid Integration

Industry: Government & Non-Profit


5 - 7 years

Posted 196 days ago

This job is no longer available.


Strategically implement and lead Neighborhoods fully integrated Medicaid and Medicare (MME/LTSS) program/product. Represents Neighborhood with key advocates and constituents (and develops strategic relationships and identifies opportunities for strategic partnerships. Works closely with Compliance to ensure all contract/regulatory and reporting requirements are met. Responsible for development of strategies that ensure continued company growth in the MME/LTSS marketplace. Cultivates and maintains strong and effective relationships internally and externally, and specifically with Centers for Medicare and Medicaid Services (CMS) and Rhode Island Executive Office of Health and Human Service (EOHHS). Full accountability for the compliance, financial success, and quality measures of the product. Creates the strategy for the product and works collaboratively across the organizations in a matrixed environment to drive product results.


Ensures Strategic Alliance

  • Leads the formulation of company strategy and product model; leads the creation of product goals, policies, short and long range strategic planning activities
  • Working closely with Business Development, builds a knowledge base of local, regional and national market trends, opportunities and threats, competitive intelligence, and product information

Manages Team Performance

  • Strategically leads a unified product development process for MME by coordinating resources across product/market groups and functions (i.e. Medical Management, Compliance, Fiscal Ops, etc.)
  • Management of professional level staff

Understands the Business

  • Develops financial model in conjunction with Fiscal Operations regarding financial goals; creates annual operating plan
  • Oversees rate analysis; assess adequacy and implications for administrative & medical budgets
  • Maintains knowledge of state and federal regulatory environments
  • Works closely with Compliance on interpretation and communication of regulatory and contractual requirements

Uses Influencing/Collaboration Skills Effectively

  • Coordinates and collaborates with business leaders across the organization to insure proper implementation and resource allocation
  • Cultivates relationship with CMS and EOHHS
  • Serves as an effective Medicaid/Medicare expert and resource to Neighborhood’s business units. Acts as lead for CMS and State agencies related to product line

Gets Results

  • Develops and manages overall product budget based on utilization and financial data in support of product goals; Provides reporting to Senior Leadership in support of the financial health of the product
  • Owns product department policies and procedures and provides guidance and feedback on compliance
  • Accountable for internal business area compliance to regulatory and contract requirements/changes
  • Provides guidance and oversight to execution of product line deliverables
  • Provides reporting to organization in support of the financial health of the product
  • Provides analysis of product performance and escalates issues to senior management
  • Ensures compliance with all federal and state reporting requirements

Guides Innovation

  • Oversees the implementation of new programs and operational processes to ensure resource optimization and compliance
  • Analyzes best practices and plans for new product offerings
  • Facilitates ongoing discussion on product improvement/enhancements and performance improvements
  • Directs development of MME/LTSS policy/legislative strategies; provides ongoing oversight


  • Revenue generation for product
  • Performance against operational/financial targets
  • Performance of quality measures State, Federal and member satisfaction
  • Development of products that serve member needs within set cost and quality targets

Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhood’s Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies, and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect, and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents.


  • Experience in Medicare Advantage; detailed knowledge of Medicare Advantage regulations and CMS Health Management Plan Systems; Medicaid and/or LTSS experience
  • 5-8 years’ people management experience; experience leading across functions and/or matrixed teams
  • 5 - 8 years’ experience managing the financial component of a product line; P & L experience
  • Excellent qualitative analysis skills
  • Excellent collaborative skills and experience achieving results across an organization
  • Experience in representing business opportunities with Senior Executives
  • Experience in evaluating complex opportunities and providing organizational oversight to develop business solutions for such opportunities
  • Proven ability to develop strong, lasting relationships that result in favorable business opportunities and alignment of public policy to support business needs
  • Ability to build and maintain strong relationships/partnerships, both internally and externally
  • Superior oral and written communications
  • Master’s Degree or significant experience related to position duties and requirements

Organizational Competencies:

  • Judgement and Decision Making
  • Gets Results
  • Collaboration and Teamwork
  • Business Awareness
  • Customer Focus

Job Specific Competencies:

  • Attention to Detail
  • Creativity and Innovation
  • Flexibility and Achieving Change
  • Learning and Development
  • Resilience
  • Influencing and Negotiation
  • Open Communication
  • Relationship Building and Networking
  • Respecting Others and Valuing Diversity
  • Continuous Quality Improvement
  • Organizational Savvy
  • Planning and Organizing
  • Problem Solving and Analysis
  • Strategic Thinking and Alignment.