VP, Medicare

Caresource Dayton , OH 45401

Posted 3 months ago

Role and Responsibility:

  • Executive responsible for the Medicare P&L, product design, membership growth, quality, outcomes and overall product strategy to achieve corporate and health plan objectives

  • Coordinate across health plans, the formulation of strategy for Medicare products

  • Collaborate with markets and functions on the design and development of Medicare products

  • Partner with health plan Presidents to develop operating targets (budget, membership, quality goals) to ensure product success

  • Champion innovative Medicare initiatives

  • Oversee the development and product performance of Medicare products from plan design, consumer experience, quality, network, enrollment, sales and marketing, clinical and financial management

  • Maintain knowledge of key CMS regulations and ensure operationalization of requirements

  • Maintain current and accurate knowledge of Medicare Advantage best practices related to program development, financial outcomes, enrollment and marketing

  • Complete modeling and analysis of member population; direct consumer segmentation and research

  • Accountable for product performance (P&L, market share, operating targets, membership, consumer experience, quality and accreditation)

  • Collaborate with key stakeholders on consumer information and enrollment platform

  • Lead product development process for Medicare

  • Collaborate with finance to develop the finance model regarding premium, plan design and financial goals, including underwriting and actuarial analysis

  • Determine provider network strategy to drive performance and achieve outcomes

  • Perform any other job related instructions as requested

Key Decision Rights:

  • Strategy, product design and pricing

  • Annual budget and operating plan

  • Hiring of staff

Cross Functional Interactions:

  • Interact heavily with health plan presidents

  • Interact with functional owners of business partner organizations

Accountability:

  • Accountable for the Medicare P&L and membership of all associated products

  • Performance against operational/financial targets

  • Quality Scores

  • CMS & member satisfaction

Requirements

Education / Experience:

  • Bachelor's degree is required

  • Master's in Business Administration (MBA), Healthcare Administration and/or other related discipline is preferred

  • A minimum of six (6) years of experience in health plan product development or product management is required

  • Prior Medicare Advantage experience and expertise around Medicare Advantage products is required

  • Experience leading Medicare quality improvement efforts (Star rating target equals four Star rating)

  • Prior experience developing and launching Medicare Advantage programs is preferred

Required Competencies / Knowledge /

Skills:
  • Commitment to the mission and values of the CareSource Family of Companies

  • Desire to take a hands-on, operational approach

  • Strong understanding of healthcare finances

  • Strong collaborative skills, working with cross-functional stakeholders and external partners

  • Effective oral and written communication skills

  • Ability to develop and maintain strong relationships with local stakeholders

  • Ability to lead high functioning teams

Licensure / Certification:

  • None

Working Conditions:

  • General office environment; may be required to sit/stand for long periods of time

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VIEW JOBS 10/2/2018 12:00:00 AM 2018-12-31T00:00 Role and Responsibility: * Executive responsible for the Medicare P&L, product design, membership growth, quality, outcomes and overall product strategy to achieve corporate and health plan objectives * Coordinate across health plans, the formulation of strategy for Medicare products * Collaborate with markets and functions on the design and development of Medicare products * Partner with health plan Presidents to develop operating targets (budget, membership, quality goals) to ensure product success * Champion innovative Medicare initiatives * Oversee the development and product performance of Medicare products from plan design, consumer experience, quality, network, enrollment, sales and marketing, clinical and financial management * Maintain knowledge of key CMS regulations and ensure operationalization of requirements * Maintain current and accurate knowledge of Medicare Advantage best practices related to program development, financial outcomes, enrollment and marketing * Complete modeling and analysis of member population; direct consumer segmentation and research * Accountable for product performance (P&L, market share, operating targets, membership, consumer experience, quality and accreditation) * Collaborate with key stakeholders on consumer information and enrollment platform * Lead product development process for Medicare * Collaborate with finance to develop the finance model regarding premium, plan design and financial goals, including underwriting and actuarial analysis * Determine provider network strategy to drive performance and achieve outcomes * Perform any other job related instructions as requested Key Decision Rights: * Strategy, product design and pricing * Annual budget and operating plan * Hiring of staff Cross Functional Interactions: * Interact heavily with health plan presidents * Interact with functional owners of business partner organizations Accountability: * Accountable for the Medicare P&L and membership of all associated products * Performance against operational/financial targets * Quality Scores * CMS & member satisfaction Requirements Education / Experience: * Bachelor's degree is required * Master's in Business Administration (MBA), Healthcare Administration and/or other related discipline is preferred * A minimum of six (6) years of experience in health plan product development or product management is required * Prior Medicare Advantage experience and expertise around Medicare Advantage products is required * Experience leading Medicare quality improvement efforts (Star rating target equals four Star rating) * Prior experience developing and launching Medicare Advantage programs is preferred Required Competencies / Knowledge / Skills: * Commitment to the mission and values of the CareSource Family of Companies * Desire to take a hands-on, operational approach * Strong understanding of healthcare finances * Strong collaborative skills, working with cross-functional stakeholders and external partners * Effective oral and written communication skills * Ability to develop and maintain strong relationships with local stakeholders * Ability to lead high functioning teams Licensure / Certification: * None Working Conditions: * General office environment; may be required to sit/stand for long periods of time Apply On-lineSend This Job to a Friend Copyright © Ultimate Software Caresource Dayton OH

VP, Medicare

Caresource