Vice President, Medicare

Job Summary

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 Responsibilities

Technical/Strategic Leadership

Provides strategic leadership for the Medicare line of business across the organization.
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.
Employee Supervision

Directs team(s) and establishes team direction and goals in alignment with the organizational mission, vision, and values.
Identifies work and staffing models; recruits, hires, and oversees a team to meet work needs, using an equity, diversity, and inclusion lens.
Identifies department priorities; ensures employees have information and resources to meet job expectations.
Leads the development, communication, and oversight of team and individual goals; ensures goals, expectations, and standards are clearly understood by staff.
Manages, coaches, motivates, and guides employees; promotes employee development.
Incorporates guidance from CareOregon equity tools into people leadership, planning, operations, evaluation, budgeting, resource allocation, and decision making.
Ensures team adheres to department and organizational standards, policies, and procedures.
Evaluates employee performance and provides regular feedback to support success; recognizes strong performance and addresses performance gaps and accountability (corrective action).
Performs supervisory tasks in collaboration with Human Resources as needed.

Organizational Responsibilities

Perform work in alignment with the organization’s mission, vision and values.
Support the organization’s commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.
Strive to meet annual business goals in support of the organization’s strategic goals.
Adhere to the organization’s policies, procedures and other relevant compliance needs.
Perform other duties as needed.

Experience and/or Education


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


Minimum 5 years’ experience in a supervisory position
Leadership experience in a managed care organization or in a position requiring advanced knowledge of Medicare Advantage regulations
Experience with the dual eligible population
Bachelor’s or Master’s degree in health care administration, public policy, business, or a related field
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

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