Executive Director of Market Operations

1 week ago

Nashville, Tennessee, United States VALID8 Financial Full time
Job Description

**About the Role**

We are seeking a seasoned executive to lead our market operations and drive growth in our Medicare Advantage plans. As a Market Vice President, you will be responsible for developing and executing strategies to improve the quality, affordability, and experience of healthcare for our members, while also driving operational excellence and financial performance.

Key Responsibilities:

  • Establish and maintain strong relationships with local healthcare providers and partners in the market.
  • Drive a laser focus on improving the quality, affordability, and experience of healthcare for all patients, as well as a relentless focus on improving the care delivery experience for providers.
  • Oversee the delivery of key strategic initiatives and operational plans that drive operational quality improvement, member growth, earnings, and regulatory compliance.
  • Monitor key metrics and trends in sales, risk scores, utilization, unit cost, clinical key performance indicators, and other business drivers to understand their impact on financial performance and drive necessary actions to achieve performance objectives.
  • Assist in the development of strategies to ensure continued growth and financial stability of the health plan in alignment with corporate objectives.
  • Collaborate with Finance and Performance Analysis teams to identify cost savings initiatives and monitor contract performance.
  • Control expenses by gathering and submitting budget information, scheduling expenditures, monitoring variances, and implementing corrective actions.
  • Implement operational changes in the market in concert with corporate and vendor operations to achieve financial and operations goals for both the local plan and other health plans nationwide.
  • Provide strategic/tactical direction and support to Network contracting team to ensure a strategic and CMS-adequate network that meets care, service, compliance, and financial goals.
  • Develop market team facility visit schedules, assign, and monitor work, ensure appropriate resources, implement productivity standards, resolve operations problems, maintain reference manuals, and implement new procedures.
  • Maintain working knowledge of all market key metrics, including MLR, APK, IP/OP costs, Admin costs, Hospice population, etc.
  • Maintain documentation of market-based strategies and current partner interactions, barriers, action plans, etc., to drive increased engagement and high levels of I-SNP penetration.
  • Assist in the development of market and building-specific monthly/annual enrollment targets.
  • Support Growth/BD Teams in communication to local healthcare providers that would be a good fit to offer our health plan.
  • Oversee implementation of new partner healthcare providers utilizing market team and corporate resources as needed, setting go-live dates, and ensuring necessary network agreements and clinical resources are in place.
  • Create an enrollment plan and productivity targets for each Sales Engagement Specialist in the market to grow plan membership.
  • Collaborate with our company and executive leadership to develop compensation plans for Sales Engagement Specialists and monitor on-going productivity against targets.
  • Develop materials and present during Monthly Operating Review meetings, Business Development meetings, and partner-facing Joint Operating Committee meetings.
  • Maintain a regular visit schedule for assigned healthcare providers, visiting each at least quarterly and ensuring ongoing communication with all relevant owner/operator teams.
  • In collaboration with the executive leadership team, oversee the integration and delivery of current product offerings and supplemental benefit offerings in the market.
  • Understand and facilitate legislation/regulations affecting our company in the market.
  • Develop and foster effective collaboration between corporate and functions managed directly by the market.
  • Collaborate with colleagues in operational risk, compliance, and internal quality audit to ensure that robust policies and procedures are maintained and that risks are identified and addressed quickly.
  • Function as a champion of Compliance and collaborate with corporate teams to ensure that local staff and providers complete initial and annual Compliance, Model of Care, HIPAA, and FWA training.
  • Represent our company both in external forums and develop the company brand with regulators, providers, and local healthcare partners.

Requirements:

  • MBA, MSN, or advanced degree in health care management, nursing with business education, or other relevant technical or operations field preferred.
  • Minimum of 5-10 years of health care industry experience, with Medicare expertise required (either through health plan or provider organization).
  • Strong local market knowledge of the healthcare environment and experience in Medicare Advantage marketing and sales strongly preferred.
  • Understanding of functional areas and their impact on overall performance (beyond operations, including clinical, finance, IT, compliance, and legal).
  • Knowledge of the evolving health care delivery system, including expertise in population health management, Medicare health plan operations, and value-based care delivery models, as well as a passion for improving the quality and affordability of healthcare for the frail and elderly living in nursing homes strongly preferred.
  • Strong entrepreneurial drive along with the operational skills needed to consistently drive results.
  • Excellent written and oral communication skills with internal and external business partners and employees.
  • Independent decision-maker and calculated risk-taker.
  • Strong strategic and analytical orientation with the ability to drive operational excellence and strong business performance.
  • Ability to maintain relentless personal and team focus on achieving long-term objectives in the face of potential distractions.
  • Excellent planning and problem-solving skills that enable quick identification and efficient resolution of issues.
  • Highly collaborative with the ability to influence others and build strong professional relationships, especially in a highly matrixed organization.

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