VP Medicare Programs
11 - 15 years experience • Managed Care & Health Insurance
VP, Medicare Programs – AZ
You will own the Medicare product in this developing market. Bring your own ideas and innovation to an organization that is well –positioned to dominate this market.
Incredible resources- visible role with unlimited opportunity for advancement.
Responsible for driving membership, revenue and profitability. Provide overall direction and leadership in the formation and execution of growth, operational, financial and marketing strategies. Accountable for creating the strategies to achieve the goals towards the business unit’s positioning in the market. Defines the strategies to achieve profitability goals related to Medicare programs.
• Oversees benefit design, consistent market, competitor tracking, and integrated strategy definition.
• Develops annual Medicare market strategic plan, including long, medium and short term objectives.
• Leverages the business unit’s brand into new products by assessing appropriate product lines for the brand.
• Provides direction for ongoing market segmentation efforts and ensures the establishment of plans for desired penetration of each market.
• Maintains relationships with contracting and network management to ensure the adequacy of the Medicare hospital, physician, and ancillary network and to ensure that the network is contracted at rates that are consistent with meeting profitability targets.
• Partners with Medical Management to ensure focus on programs that meet the needs of Medicare members, improve outcomes, and lower health care costs as necessary to meet financial targets.
• Partners with Medicare Marketing and Sales to ensure the best use of resources consistent with the corporation’s values, philosophy, mission and objectives.
• Forecasts revenues and medical margin by product lineline considering membership, revenue and cost, and adjusts tactics to ensure product plans.
• Manages product development and product management to ensure product quality and revenue targets are being met.
• Identifies and evaluates the financial feasibility of prospective business opportunities and develops plans for new ventures.
• Partners with Quality to maximize performance with Medicare Stars and other quality initiatives.
Bachelor’s Degree in business administration, finance or a related field. Master's Degreepreferred
• 10+ years senior management experience with extensive Medicare operational accountability
• Broad knowledge of managed care and government programs
• Experience with outside regulators, governmental entities, etc
• Experience with operational budget development and management, as well as and market research & competitor analysis
• You can lead through influence and expertise as opposed to simply authority
• Ability to drive major components of Medicare operations