Vice President of Medicare

The Impact You Will Have

The Vice President of Medicare owns the growth and revenue strategy and execution. Serves as an executive leader for Medicare and Value Performance, helping guide and support the organization’s overall direction.

This executive will be a market leader who represents the Medicare business in the market and develops relationships that support growth, distribution, and partnership strategies. This individual is accountable for the P&Ls of Medicare plans with a strong focus on achieving membership and operating margin performance. The VP will develop, execute, and manage the product strategy, end-to-end performance management, and overall strategic plan objectives for existing and future expansions of the Medicare markets.

In addition to leading the Medicare P&L, the VP will drive cross-enterprise influence to ensure quality and risk adjustment strategic goals are delivered upon in all lines of business.

• Full P&L responsibility for Medicare, including attainment of profit and loss, revenue, membership enrollment and retention, market share, quality ratings (HEDIS, Stars, etc.), medical and administrative expense targets, as well as member services SLAs, regulatory and compliance requirements (NCQA) for each market segment.
• Develop and execute short- and long-term strategic plans that drive growth and performance of Medicare Markets. A main focus of role is to create a sustainable and stable Medicare Advantage program.
• Influence activities for Star improvement and risk adjustment optimization to ensure that the maximum benefit is derived with minimized provider and member abrasion.
• Foster strong local relationships (e.g., regulators, navigators/enrollment assistants). Maximize Medicare value proposition through partnerships with key matrix organizations (network, contracting, medical management, distribution, account management, product, etc.).
• Collaborate with internal business functions (Finance, Actuarial, Quality & Member Experience, Population Health Management, Enrollment, Operations, Marketing, Provider Partnerships, Legal, IT, etc.) to execute on performance management and improvement initiatives for the Medicare markets. Jointly develop performance metrics with internal colleagues that help hold the organization accountable in a collaborative and productive manner.
• Foster strong partnership with marketing and community relations teams to ensure adequate lead generation to drive sales, timely and effective communications with members and provider partners in line with CMS requirements and guidelines, and positive brand awareness building in order to promote active selection among eligible populations. Builds and maintains relationships with senior advocacy groups.
• Communicates clearly and persuasively to build support for initiatives, engaging both internal and external stakeholders.
• Manages and guides direct reports and the division toward accountable, goal-oriented outcomes aligned with enterprise strategy.

• Minimum of a bachelor’s degree in business, healthcare, or related field equivalent experience.
• 10 years in market management, product management or segment strategy role, Medicaid, or Medicare.
• 7 years owning and managing P&L in healthcare or 5 years minimum P&L ownership in Medicare.
• 3 years market leadership within assigned market(s), strongly preferred in Medicare business with deep knowledge of Star/Quality and Risk adjustment programs.
• High school diploma (or equivalency) and legal authorization to work in the U.S.
• Accepting this position at BCBSMN requires signing an Employee Confidentiality, Intellectual Property Assignment and Restrictive Covenants Agreement as a condition of employment.

• Demonstrated track record of ownership and achievement of bottom-line results by managing well-crafted strategic plans.
• Demonstrated experience leading/owning membership / financial forecasting.
• Developed expertise in Contracting, Product, Provider Relations and Medical Management such that incumbent can leverage support needed to deliver the right customer solution.
• Proven experience analyzing…