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VP, Dual Special Needs Plan
BlueCross BlueShield of TennesseeSenior Executive Leader for BlueCare Plus D‑SNP overseeing Medicare operations. Aligning product strategy, ensuring compliance, and enhancing member satisfaction and performance outcomes.
About the role
Key responsibilities & impact- Responsible for the Profit and Loss of the business segment
- Provide strategic direction to senior management team to ensure operations support enterprise strategies, performance guarantees customer satisfaction and competitive positioning
- Collaborate with Medicare and BlueCare business leaders to ensure alignment across products and initiatives
- Oversee Medicare Dual Special Needs Plan products operations, including timely development and submission of the annual bid
- Ensure effective contract administration by projecting funding needs and negotiating budget settlements consistent with CMS funding and organizational requirements
- Drive achievement of required D‑SNP performance measures in partnership with Corporate Quality, including audit readiness and reimbursement activities
- Monitor and interpret regulatory and program changes impacting Medicare products and ensure ongoing contract compliance, including fraud, waste, and abuse requirements
- Oversee implementation of product changes and maintain strong cross-functional partnerships to support operational, network, and enterprise objectives
- Build and maintain effective working relationships with CMS, TennCare and other federal and state bodies as it relates to the line of business
- Recruit, develop and lead a high-performing management
Requirements
What you’ll need- Bachelor’s degree in business or healthcare related field, or equivalent proven work experience required
- 8 years of progressively responsible management in Medicare health insurance products required
- Minimum of 5 years in Medicare Advantage specific, with Dual Special Needs Plan experience preferred
- Proven background in the development, implementation and/or administration of Medicare Advantage products is required
- Proven understanding of provider payment reimbursement methodologies in a Medicare Advantage environment is required, Medicaid experience preferred
- Proven strong leadership to direct a team to achieve high performance and goals
- Ability to understand the technical issues of healthcare financing and administration
- Proven leadership skills, superior communication and organizational skills
- Knowledge and experience in the use of financial and operations performance data and information as it pertains to members and providers is preferred
- Proven ability to conduct root cause analysis, plan, organize, and coordinate multiple projects
Benefits
Comp & perks- Health insurance
- 401(k) matching
- Remote work options
ATS Keywords
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Hard Skills & Tools
Medicare AdvantageDual Special Needs Plancontract administrationprovider payment reimbursement methodologiesfinancial performance data analysisoperations performance data analysisroot cause analysisproject management
Soft Skills
leadershipcommunicationorganizational skillscollaborationstrategic direction
Certifications
Bachelor’s degree in business or healthcare related field