Vice President, Medicare and Individual

1 month ago

Bend, United States PacificSource Full time
Looking for a way to make an impact and help people?

Join PacificSource and help our members access quality, affordable care

PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.

The Vice President of Medicare and Individual is a member of PacificSource's Executive Management Group charged with building, overseeing, and driving the success of our Medicare and Individual lines of business. This role is responsible for building and executing a profitable growth strategy for both lines of business. The Vice President of Medicare and Individual will be the subject matter expert, champion, and senior leader with direct responsibility for Medicare Advantage, Dual Special Needs Plan (DSNP), and Individual segments (on and off exchange) and corresponding accountability for profit and loss (P&L), strategic planning, and execution against strategies. This position develops strategic plans and annual work plans for each line of business consistent with PacificSource's enterprise strategy and is responsible for gaining senior leadership agreement for investments, allocations, and initiatives that deliver on the strategic plan. This role also manages a leadership team to deliver on the strategic plan and works collaboratively with other leaders. This work includes leading internal teams (both direct and shared services) and external partners in aligning strategic planning efforts, resource allocation, and management objectives to ensure success.

Essential Responsibilities:
  • Manage the P&L for the line of business.
  • Develop and execute a strategic plan and annual work plan for the Medicare and Individual lines of business.
  • Provide strategic leadership for lines of business across the organization.
  • Develop and lead a governance model that ensures alignment and execution of the work necessary for both lines of business working across intersecting departments, matrixed relationships, and external parties.
  • Ensure both lines of business meet all Centers for Medicare and Medicaid Services (CMS) and state regulatory and contractual requirements.
  • Maintain an enterprise view of PacificSource while establishing Medicare and Individual priorities, consistent with a deep understanding of the attributes required for success in government-regulated and publicly subsidized health care programs.
  • Build and maintain relationships with PacificSource's Medicare and Individual provider partners, brokers, regulators, and other internal and external stakeholders, including the Medicaid and Employer Group lines of business. Align strategies and tactics to achieve a competitive position, profitable lines of business, superior market share, and sustained competitive advantage.
  • Ensure that critical initiatives and projects are adequately planned, resourced, and executed.
  • Develop strategic business partnerships with internal departments and leaders to ensure strong operating performance, high levels of member satisfaction and quality performance, access, compliance and audit readiness, and sound financial performance. Develop and monitor departmental and lines of business budgets.
  • Maintain optimal alignment and visibility for Medicare and Individual initiatives at all levels of the company through presentations, maintenance of monitoring dashboards, and integration with departmental and individual performance objectives, and deploy efforts to consistently, transparently, and effectively relay strategic messages to the management team and staff.
  • Supervise departments and employees, and manage, coach, motivate, and guide employees.
  • Conduct market research, competitive analysis, and financial assessments to evaluate improvement opportunities and business strategies in concert with PacificSource's vision, values, and enterprise strategy.
  • Support the organization's commitment to diversity, equity, inclusion, and belonging by fostering a culture of dignity, cultural awareness, compassion, and respect.
  • Work closely with the Compliance Department and others to ensure policies, procedures, workflows, lifecycle strategies, product offerings, and success initiatives comply with state and federal regulations.
  • Closely monitor policy, legislative and competitive developments, and Medicaid priorities that impact the lines of business. Translate these impacts to the organization and lead communication, planning, and implementation efforts required for the organization to respond.
  • Represent PacificSource externally in community, state, regional, and industry forums.
  • Lead the enterprise organization as a member of the Executive Management Group. Actively participate as a key team member in company leadership and manager meetings.
  • Responsible for hiring, staff development, coaching, performance reviews, corrective actions, and termination of employees. Provide feedback, including regular one-on-ones and performance evaluations, for direct reports.

Supporting Responsibilities:
  • Meet department and company performance and attendance expectations.
  • Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
  • Perform other duties as assigned.

SUCCESS PROFILE

Work Experience: Minimum of ten years of related experience, including at least five years in a leadership capacity in managed care. Experience with direct profit and loss accountability, strategic planning, marketing/communications, sales, product development, and managing teams required. Leadership experience in a managed care organization requiring advanced knowledge of Medicare Advantage and Individual regulations required. Experience with the dual-eligible population strongly preferred.

Education, Certificates, Licenses: Bachelor's degree required with a focus in health care administration, business, public policy, public health, or a related field preferred. Master's degree or other advanced degree strongly preferred.

Knowledge: Advanced knowledge of Medicare, the Medicare Advantage program, and CMS required, along with deep understanding of the key attributes, competencies, and strategies for success. Advanced knowledge of Individual on-and-off-exchange offerings, CMS, state-based and federally facilitated marketplaces, and state regulation required, along with deep understanding of the key attributes, competencies, and strategies for success. Strong understanding of managed care and publicly financed or subsidized health care, including the intersection between retail Medicare Advantage, DSNP, and Medicaid. Demonstrated track record of achieving annual profitability goals. Proven leadership in managing large, cross-functional organizations and developing and implementing sales, marketing, and operating and growth plans to meet profitability targets. Demonstrated experience and success in working collaboratively in defining and achieving common goals, including the ability to create a vision that will inspire others. Ability to communicate, persuade, convince, influence, and negotiate with all levels within and outside of PacificSource, including staff, management, boards of directors, employees and community stakeholders. Ability to create synergy by facilitation collaboration among independent entities. Comprehensive knowledge of business principles and administration, organization, and management activities. Health care leadership, planning, and development experience with in-depth understanding of health care issues and trends.

Competencies

Authenticity

Establishing strategic direction

Customer focus

Leading change

Empowerment/delegation

Building organizational talent

Coaching and developing others

Passion for results

Cultivating networks

Emotional intelligence

Optimizing diversity

Environment: Work remotely and inside in a general office setting with ergonomically configured equipment. Travel is required approximately 20% of the time.

Skills:
Accountable leadership, Business & financial acumen, Developing Networks, Driving initiatives, Empowerment, Influential Communications, Inspirational Leadership

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:
  • We are committed to doing the right thing.
  • We are one team working toward a common goal.
  • We are each responsible for customer service.
  • We practice open communication at all levels of the company to foster individual, team and company growth.
  • We actively participate in efforts to improve our many communities-internally and externally.
  • We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
  • We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

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