CareFirst BlueCross BlueShield · 17 hours ago
Vice President, Medicare Programs (Hybrid)
Reston, VA
Full-time
Hybrid
Director/Executive
$220K/yr - $330K/yr
15+ years expCareFirst BlueCross BlueShield is a health insurance company focused on providing Medicare programs. The Vice President will lead the operation of all Medicare programs, ensuring profitability and growth while managing product strategy and performance across multiple teams.
Health CareNon ProfitService Industry
No H1B
Responsibilities
Lead and oversee measures management for Medicare products in all markets
Ensure Medicare strategic plans are translated into tactical goals, objectives and lead measures that guarantee performance measures are met or exceeded
Partner with executive shared services teams to ensure that enterprise-wide quality, operational, financial and leadership expectations are met
Partner with VP, Medicaid to ensure Medicare priorities are clear and execution occurs in line with expectations in those matrixed markets
Collaborate with cross functional leaders to identify and implement opportunities for improved business performance
Lead, direct and oversee operational management for Medicare products in all markets
Ensure Medicare strategic plans and customer experience strategy are translated into tactical goals, objectives and lead measures that guarantee operational objectives are met or exceeded
Collaborate with cross functional leaders to identify and implement opportunities for improving operational performance
Develop and lead Medicare vendor strategy to support all operational functions of Medicare Programs that meets or exceeds operational management goals, objectives and lead measures
Collaborate with vendor management team(s) to ensure acquisition of services required to support vendor strategy and ongoing relationship management, including adherence to all business and administrative regulations
Collaborate with Director of Compliance, Consumer Government Programs and Medicare Compliance Officer, to ensure compliance with all business, administrative and relevant federal, State and local regulations
Develop and oversee implementation of annual business plan
Collaborate with VP, Chief Marketing Officer to define the product strategy and develop innovative and highly competitive product offerings and services to support growth, earnings and CareFirst mission
Establish customer experience strategy across Medicare programs
Establish the business objectives for critical functions that impact business performance (including functions such as contracting, population health, provider performance management, operations, risk adjustment and medical cost management)
Work with matrixed business leaders in these functions as they develop strategies to execute on these defined business objectives
Establish business objectives for membership growth, including acquisition and retention objectives
Leverage sales distribution channels and strategic provider and community relationships
Collaborate with VP, Chief Marketing Officer on the development and execution of value propositions, market positioning and voice to consumers, brokers and affinity partners
Assess changes in the external environment including state and federal government, identify implications and develop plans to address
Collaborate with VP of Strategy and Business Delivery to support strategy development and monitoring, and delivery of technical solutions to support Medicare programs
Provide input to SVP Consumer Government Programs and function leaders on issues impacting business success including medical cost innovation, quality, operations, member experience and government affairs
Lead financial performance of all Medicare plans to meet membership, earnings and quality targets
Take appropriate actions to increase revenue, leverage resources, manage and/or minimize expenses and drive medical expense initiatives
Partner with Director of Finance, Consumer Government Programs to develop the annual fiscal operating budget to ensure financial goals and supporting operational objectives are met
Provide executive profit and loss (P&L) leadership, direction and operational oversight
Accountable for successful deployment of the budget to deliver required growth in membership, manage medical loss ratio and achieve quality and member satisfaction goals
Collaborate with a matrixed cross-functional team to identify opportunities to improve performance and develop plans to drive growth, manage medical cost and utilization and improve quality
Oversee the strategic and the day-to-day activities of the Department, including directing, coaching, and guiding associates to implement departmental, divisional, and organizational mission/goals
Recruit, retain and develop a high performing team
Evaluate performance of each team member, generates development plans and sets goals within the context of the corporate policies and procedures
Develop annual goals, and prepares, monitors, and analyzes variances of departmental budgets to control and appropriately allocate resources
Qualification
Required
Bachelor's Degree
Minimum of 15 years of progressively responsible management experience in managed care insurance, finance, health care setting or related field
Minimum of 5 years of business unit leadership with P&L responsibility and a proven ability to drive membership growth and profitability
Medicare managed care experience
Experience in at least one of the following: product strategy, network management, risk adjustment, Medicare compliance or medical cost management
Preferred
Advanced degree in business or related field
Experience in Medicare Advantage Group, Medicaid and/or Dual-Eligibles
Benefits
Comprehensive benefits package
Various incentive programs/plans
401k contribution programs/plans
Company
CareFirst BlueCross BlueShield
CareFirst. It’s not just our name. It’s our promise.
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
Ja'Ron Bridges
Interim President and Chief Executive Officer
Doba Parushev
Vice President, Healthworx Ventures
Recent News
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