Anthem, Inc. Regional Vice President Medicare Market Performance (KY, OH, OR TN) in Lexington, Kentucky
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This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health care companies and a Fortune Top 50 Company.
Title: Regional Vice President Medicare Market Performance
Locations: KY, OH, OR TN
The RVP is responsible for developing and implementing strategic plans to achieve growth and profitability objectives for all Medicare products in a multi-state region, reporting to the Medicare President, Central Region. The RVP will lead, directly and through a partnership with matrixed business partners, plan activities to drive improvement in Medicare Stars scores, accurate documentation for risk adjustment purposes, and the development of successful value-based relationships to improve outcomes for members. The RVP will be responsible for driving network and value-based incentive strategy and partnering with the contracting organization to execute plans. The RVP will be responsible for analyzing the market and competitive trends to support product and distribution strategy in each state.
Primary duties may include but are not limited to:
Manages the health plan's P&L to include revenue, cost management, SG&A, and forward-looking product growth opportunities
Oversees and participates in medical management, including hospital census review, medical staffing, seasonality issues, detailed communications with the medical director and nurse leader, and monthly accrual analysis
Oversees and participates in the development of growth strategies and retention initiatives for the health plan
Oversees marketing and product growth strategies and business initiatives as well as school-based, faith-based, community-based, and special needs initiatives
Drives provider collaboration and engagement in the areas of service and Payment Innovation with a deep partnership with the Provider Services Organization
Develops and implements network strategies specific to local markets in the assigned multi-state geography, including identifying and cultivating strategic alliances and building new network models with significant provider organizations
Provides local strategic insight into the design and implementation of high-performance networks to include facility and provider performance incentives
Responsible for health plan budgeting and financials, including management of expenses, financial reports delivered to the State, capital budget planning, and management
Ensures contract and HIPAA compliance, including securing and coordinating resources necessary for such compliance
Certifies monthly and quarterly financial statements, encounter reporting, quality audits, HEDIS/EPSDT, and other required regulatory reports
Oversees risk management program, including fraud and abuse program compliance, and reporting responsibilities
Hires, trains, coaches, counsels and evaluates performance of direct reports
8+ years Medicare Network experience
Provider consulting experience utilizing data to drive conversations
Experience presenting Quality, Hedis and STAR scores data to leadership
15 years of in-depth experience in the HMO/healthcare field
10 years of successful management experience with a demonstrated record of hiring and developing direct reports and extended leadership teams; or any combination of education and experience which would provide an equivalent background
12+ years of experience in health care environment
8 years of experience working with government-sponsored health care programs; or any combination of education and experience, which would provide an equivalent background
Certified Professional Healthcare Quality (CPHQ) preferred
Requires a BA/BS in Business, Healthcare Administration or related field
Experience in managed care for government-sponsored programs preferred
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.