Senior Vice President, Medicare

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

•Accountable for the Medicare P&L and membership of all associated products
•Performance against operational/financial targets
•Quality Scores
•CMS & member satisfaction

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:

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

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