Vice President, Medicare

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General Statement of Duties
The Vice President of Medicare is responsible for strategy and execution of the Medicare Advantage line of business. The majority of time is focused on enterprise-wide engagement, with secondary time on business group oversight. Primary duties include strategic planning and operational effectiveness, as well as development and oversight of resources, relationships and teams. The position will accomplish goals within a matrixed team approach that involves staff across the organization and actively and regularly participates in strategic planning and collaboration.

Essential Position Functions

Technical/Strategic Leadership

Provides strategic leadership for the Medicare line of business across the organziation.
Oversees problem identification, solution development and implementations necessary to ensure the performance of the Medicare line of business.
Develops and leads a governance model that ensures understanding and alignment of the Medicare program across intersecting departments, matrixed relationships and external parties.
Ensures the development and deployment of reporting and analytics utilized to oversee Medicare’s operations and support strategic efforts.
Ensures internal systems, controls and measures are in place to enhance effective, efficient and compliant operations.
Identifies performance metrics and ensures the timely and accurate monitoring and reporting of performance against metrics.
Ensures the Medicare program meets all CMS, OHA, contractual and other requirements.
Promotes innovation, process review and continual improvement.
Serves as a sponsor for key projects and initiatives.

Strategic Planning

Leads the development of vision, goals, and strategic plans for the Medicare line of business.
Develops and refines strategic plans in alignment with organizational vision and goals.
Defines operational structure for areas of oversight and approves policies.
Participates in the strategic planning process for the organization.
Maintains an enterprise view while establishing business unit priorities.

Financial/Resource Management

Develops budgets in alignment with strategic planning.
Ensures teams have sufficient resources to perform their work.
Ensures budgets are monitored and managed effectively across areas of oversight.
Approves resource allocations within budget, including people, finances, and timelines; make decisions on exceptions.

Relationship Management

Ensures strategic messages are regularly and effectively relayed to management team and staff; promotes transparency.
Leverages current relationships and forges and leverages new relationships with community partners, provider networks, and other constituents in alignment with organizational direction and priorities.
Collaborates with leaders across the organization in identifying integrated improvement strategies and ensuring meaningful integration.
Represents the organization in external meetings and functions, providing strong leadership presence and effectiveness.

People Management

Directs teams and establishes team and management direction and goals.
Provides team members with ongoing understanding of the strategic direction of the organization.
Performs employment functions in collaboration with Human Resources, including staffing, recruitment, performance management, professional development, and termination.
Coaches, inspires, and recognizes staff.
Creates opportunities for professional development.
Promotes participation in training initiatives and organizational activities, as well as adherence to external regulations and internal policies.
Fosters a culture of success in alignment with the organizational mission, vision, and values.

Essential Organizational Functions
Supports and operates in alignment with the organization’s core values.
Strives to meet work goals that contribute to departmental and organizational goals.
Adheres to organizational standards, policies and procedures, as well as compliance requirements.
Performs other duties as assigned.

Technical Knowledge, Skills and Abilities Required

Advanced knowledge of Medicare, the Medicare Advantage program and CMS
Strong understanding of managed care and publicly-financed health care stewardship principles
Understanding of best practices that drive an environment of continuous improvement
Leadership effectiveness and ability to design and implement constructive change
Highly effective written and verbal communication skills, as well as strong presentation skills
Possess a high degree of initiative and motivation along with the ability to effectively collaborate and plan with departmental leadership and staff, and other stakeholders/customers
Highly effective strategic planning and resource management skills
High degree of diplomacy, credibility and persuasiveness to consistently cultivate effective working relationships across a matrixed organization; ability to effectively express ideas and gain acceptance
Ability to work in an environment with diverse individuals and groups

Physical Skills and Abilities
Lifting/Carrying up to 0 Pounds

Pushing/Pulling up to 0 Pounds

Pinching/Retrieving Small Objects



Climbing Stairs

Repetitive Finger/Wrist/Elbow/

Shoulder/Neck Movement

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0 hours/day

0 hours/day

0 hours/day

0 hours/day

0 hours/day

3-6 hours/day








Speaking Clearly

0 hours/day

0 hours/day

0 hours/day

0 hours/day

More than 6 hours/day

3-6 hours/day

More than 6 hours/day

3-6 hours/day

Cognitive and Other Skills and Abilities

Ability to focus on and comprehend information, learn new skills and abilities, assess a situation and seek or determine appropriate resolution, accept managerial direction and feedback, and tolerate and manage stress.

Education and/or Experience


Minimum 12 years’ related experience, including 5 years’ experience in managed care or health plan functions
Minimum 5 years’ experience managing people

Bachelor’s or Master’s degree in health care administration, public policy, business or a related field
Management experience in a managed care organization
Leadership experience requiring advanced knowledge of Medicare Advantage regulations
Experience with the dual eligible population

Working Conditions

Environment: This position’s primary responsibilities typically take place in the following environment(s) (check all that apply on a regular basis):
☒ Inside/office ☐ Clinics/health facilities ☐ Member homes

☐ Other_________________________________________

Travel: This position may include occasional required or optional travel outside of the workplace, in which the employee’s personal vehicle, local transit, or other means of transportation may be used.
Equipment: General office equipment
Hazards: n/a

Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment

Veterans are strongly encouraged to apply.

Equal opportunity employer. This company considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.

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