Senior Vice President – Managed Care

This is a fully remote position, open to applicants in South Carolina.

📋 Description

• Create and implement the strategic vision for the Managed Care division.

• Offer executive leadership and oversee operations for Medical Management, Bill Review, Pharmacy Benefit Management, Ancillary Services, Provider Networks, and associated operations.

• Set, track, and report on operational, financial, client savings, service quality, and productivity metrics.

• Evaluate performance to enhance client outcomes, drive revenue growth, increase margins, boost efficiency, and improve scalability.

• Develop and consistently refine policies, processes, best practices, and management methodologies.

• Lead organizational planning, budgeting, forecasting, capital planning, and allocation of resources.

• Build, mentor, and cultivate leadership teams through coaching, succession planning, talent development, and performance management.

• Establish and maintain strategic partnerships with vendors, provider networks, business associates, consultants, prospects, and clients.

• Negotiate agreements with vendors and partners while overseeing service-level, financial, regulatory, and contractual performance.

• Ensure adherence to federal, state, industry, accreditation, contractual, and internal standards.

• Collaborate with Sales, Business Development, Client Services, Marketing, Finance, Information Technology, Compliance, Legal, and Operations departments.

• Assist sales and client-facing initiatives through presentations, finalist meetings, RFPs, client strategy sessions, conferences, and C-suite presentations.

• Present operational performance, financial outcomes, strategic initiatives, and recommendations to executive leadership and the Board of Directors.

• Identify market trends, emerging technologies, regulatory changes, and competitive opportunities.

• Drive enterprise-wide process improvements, automation, technology implementations, and operational transformation initiatives.

• Communicate and reinforce the Company’s mission, vision, values, and culture.

• Carry out other duties and special projects as assigned by the President.

⛳️ Requirements

• Bachelor's degree required; master's degree preferred.

• 15 or more years of progressively responsible leadership experience.

• Background emphasizing operational performance, employee management, financial accountability, and business growth.

• Proven history of enhancing operations, boosting revenue, managing budgets, and leading a business worth $30–60M.

• Progressive experience in insurance services, managed care, or a related industry.

• Strong understanding of statutory regulations, managed care services, vendor management, contract negotiations, and customer service delivery.

• Experience supervising both direct and indirect reports, including remote teams.

• Capability to manage a comprehensive suite of customer services, including ongoing maintenance and issue resolution.

• Outstanding written and verbal communication skills.

• Experience presenting to C-suite audiences, Boards of Directors, prospects, clients, and participants at industry conferences.

• Willingness to travel approximately 10%–20%, which may include overnight, local, and out-of-state assignments.

• Proficient with computers, laptops, standard office equipment, mobile devices, and office software.

🏝️ Benefits

• Fully remote work option available.

• Hybrid work at one of the company’s office locations is preferred.

• Professional business attire suitable for client meetings, presentations, conferences, and both in-office and virtual work.

• Occasional travel opportunities for client meetings, industry conferences, conventions, business development activities, vendor meetings, training sessions, and internal staff meetings.