- Manage the health plan(s) P&L to include revenue, cost management/Cost of Care, SG&A, and forward-looking product growth opportunities.
- Collaborate with growth partners in the execution of service deliverables, manage the resolution of escalated issues, and ensure that growth partners are following through on performance metrics.
- In collaboration with Product, Actuary, and Finance, lead the annual bid strategy, process, and submission and oversee the successful implementation of plan changes.
- Oversee and participate in medical management, medical staffing, seasonality issues, detailed communications with the medical director, and nurse leader. Collaborate with HSO and Carelon on clinical Models of Care to best manage CSNP and to grow CSNP, as well as to drive Stars performance.
- Oversee and participate in the development of growth strategies and retention initiatives for respective markets.
- Oversee marketing, retention, experience, and product growth strategies and business initiatives as well as school-based, faith-based, community-based, and special needs initiatives.
- Oversee Stars and Risk Adjustment performance and local market strategies with providers and other key stakeholders.
- Drive provider collaboration and engagement in the areas of service and Payment Innovation with deep partnership with Health Care Networks (HCN). Oversee value-based provider performance.
- Develop and implement network strategies specific to local markets, identifying and cultivating strategic alliances, network adequacy and network development for service area expansion, building new network models with significant provider organizations, and providing local strategic insight into the design and implementation of high-performance networks, including facility and provider performance incentives.
- Work with growth partners to implement whole health and health equity strategies and programs to improve member health.
- Ensure Compliance and performance management in collaboration with the Compliance team, growth partners, and the health plan, relative to CMS rules and expectations. Work with growth partners to reduce compliance actions and points.
- Oversee state SMAC (DSNP) contract requirements for regulatory reporting, encounter reporting, quality audits, HEDIS/EPSDT, state relationships for DSNP, and other contract requirements. Ensure county expansion is in alignment with Medicaid growth goals and LTSS strategies.
- Oversee Alliance contract requirements and performance, growth strategies, and long-term strategies to maintain or grow contract for new products.
- Nurture alliance relationships and partnership.
- Collaborate with peer Commercial and Medicaid Presidents in your health plans/markets on key growth, provider, community, and catcher's mitt strategies.
- Support internal Business Operating Review leadership presentations.
- Hire, train, coach, counsel, and evaluate performance of direct reports and lead with our Culture principles and behaviors.
- Previous experience in managing P&L's in large complex matrixed organizations.
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RVP & President Medicare Market (Midwest Region) - Waukesha, United States - Elevance Health
Description
Anticipated End Date:Position Title:
RVP & President Medicare Market (Midwest Region)
Job Description:
RVP & President Medicare Market (Midwest Region)
Location: This role requires the leader to be based in Wisconsin Missouri, or Iowa. Relocation assistance may be available.
Summary
Responsible for the fiscal, operational, and regulatory management for both large and complex Medicare Health plans in multiple states, specifically the Northeast region, including the following states: WI, MO, and IA. The role aligns strategy to achieve business goals.
Position Responsibilities
Requires a BA/BS degree in a related field and a minimum of 12 years of related experience, including 8 years of experience in government sponsored health insurance programs and prior leadership experience; or any combination of education and experience, which would provide an equivalent background. Master's degree preferred. Travel may be required.
Preferred Skills, Capabilities and Experiences
Staff/Regional VP
Workshift:
Job Family:
BUS > Strategy, Planning & Execution
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact for assistance.
