RVP & President Medicare Market (Ohio)

Location: This role requires the leader to be based in Ohio. Relocation assistance may be available.

Summary

Responsible for the fiscal, operational, and regulatory management for both large and complex Medicare Health plans in Ohio. The role aligns strategy to achieve business goals.

Position Responsibilities

• 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.

Position Requirements

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

• Previous experience in managing P&L's in large complex matrixed organizations.