VP, Dual Special Needs Plan

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

📋 Description

• Accountable for the Profit and Loss statements of the business segment.

• Provide strategic guidance to the senior management team to ensure that operations align with enterprise strategies, guarantee customer satisfaction, and maintain competitive positioning.

• Partner with Medicare and BlueCare business leaders to ensure consistency across products and initiatives.

• Supervise operations of Medicare Dual Special Needs Plan products, including the prompt development and submission of the annual bid.

• Ensure efficient contract management by forecasting funding requirements and negotiating budget settlements that comply with CMS funding and organizational standards.

• Drive the attainment of required D‑SNP performance metrics in collaboration with Corporate Quality, encompassing audit preparedness and reimbursement processes.

• Track and analyze regulatory and program changes affecting Medicare products, ensuring continuous contract compliance, including adherence to fraud, waste, and abuse stipulations.

• Manage the implementation of product modifications and cultivate strong cross-functional partnerships to support operational, network, and enterprise goals.

• Establish and sustain effective working relationships with CMS, TennCare, and other federal and state entities concerning the line of business.

• Recruit, mentor, and lead a high-performing management team.

⛳️ Requirements

• Bachelor’s degree in business or a healthcare-related field, or equivalent demonstrable work experience is required.

• A minimum of 8 years of progressively responsible management experience in Medicare health insurance products is required.

• At least 5 years of specific experience in Medicare Advantage, with a preference for those with Dual Special Needs Plan expertise.

• A proven track record in the development, implementation, and/or administration of Medicare Advantage products is essential.

• A solid understanding of provider payment reimbursement methodologies within a Medicare Advantage context is required; Medicaid experience is a plus.

• Demonstrated strong leadership abilities to guide a team towards achieving high performance and objectives.

• Capacity to grasp the technical aspects of healthcare financing and administration.

• Proven leadership skills along with exceptional communication and organizational abilities.

• Familiarity and experience with financial and operational performance data as it relates to members and providers is preferred.

• Proven capability to conduct root cause analysis and effectively plan, organize, and coordinate multiple projects.

🏝️ Benefits

• Health insurance.

• 401(k) matching.

• Remote work options.