VP, Medicare Market Operations – Business Performance
Job Description:
• Lead enterprise oversight of Medicare market operational and financial performance across multiple geographies.
• Drive accountability for membership growth, medical cost performance, quality outcomes, and operating margin.
• Translate large-scale operational, financial, and clinical data into strategic insights and market interventions.
• Identify emerging trends in medical cost, utilization, risk adjustment, and member engagement and deploy targeted performance improvement strategies.
• Partner with finance and actuarial leaders to manage Medical Loss Ratio, administrative cost efficiency and margin improvement.
• Align operational priorities across the enterprise to ensure consistent delivery of Medicare strategy at the market level.
• Monitor competitive market dynamics, regulatory developments, and demographic trends affecting Medicare markets.
• Build and lead a high-performing team responsible for Medicare market analytics, operational strategy, and performance governance.
• Foster a culture centered on accountability, transparency, and data-driven decision making.
Requirements:
• Bachelor’s degree required; MBA, MHA, MPH, or related graduate degree strongly preferred
• 15+ years of leadership experience in healthcare or health insurance
• Deep experience in Medicare Advantage operations and market performance management
• Demonstrated success managing large-scale operational and financial performance in complex, matrixed organizations
• Experience driving enterprise performance improvement initiatives using advanced analytics
• Strong familiarity with Medicare regulatory, reimbursement, and quality frameworks
• Enterprise strategic thinking
• Advanced financial and analytical acumen
• Executive communication and stakeholder influence
• Ability to translate data into actionable business strategy
• Proven ability to lead transformation across highly matrixed organizations.
Benefits:
• Health insurance
• Retirement plans
• Paid time off
• Flexible work arrangements
• Professional development
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• Lead enterprise oversight of Medicare market operational and financial performance across multiple geographies.
• Drive accountability for membership growth, medical cost performance, quality outcomes, and operating margin.
• Translate large-scale operational, financial, and clinical data into strategic insights and market interventions.
• Identify emerging trends in medical cost, utilization, risk adjustment, and member engagement and deploy targeted performance improvement strategies.
• Partner with finance and actuarial leaders to manage Medical Loss Ratio, administrative cost efficiency and margin improvement.
• Align operational priorities across the enterprise to ensure consistent delivery of Medicare strategy at the market level.
• Monitor competitive market dynamics, regulatory developments, and demographic trends affecting Medicare markets.
• Build and lead a high-performing team responsible for Medicare market analytics, operational strategy, and performance governance.
• Foster a culture centered on accountability, transparency, and data-driven decision making.
Requirements:
• Bachelor’s degree required; MBA, MHA, MPH, or related graduate degree strongly preferred
• 15+ years of leadership experience in healthcare or health insurance
• Deep experience in Medicare Advantage operations and market performance management
• Demonstrated success managing large-scale operational and financial performance in complex, matrixed organizations
• Experience driving enterprise performance improvement initiatives using advanced analytics
• Strong familiarity with Medicare regulatory, reimbursement, and quality frameworks
• Enterprise strategic thinking
• Advanced financial and analytical acumen
• Executive communication and stakeholder influence
• Ability to translate data into actionable business strategy
• Proven ability to lead transformation across highly matrixed organizations.
Benefits:
• Health insurance
• Retirement plans
• Paid time off
• Flexible work arrangements
• Professional development
Apply tot his job
Apply To this Job