Vice President, Operations
Vice President, Operations
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 remediating areas 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 product bids.
- 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 Models
- 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 and physicians