The Vice President of Dual Eligible Plans will serve as the both Executive Director of Boston Medical Center Health Plan’s (BMCHP or Plan) Dual Eligible Special Needs Plan (D-SNP) and Medicare Medicaid Pan (MMP). The Vice President will formulate and execute on the strategic direction of the D-SNP/SCO and the MMP in collaboration with executive leadership to achieve corporate goals. The VP will oversee all aspects of the management of both the D-SNP/SCO and MMP including building and directing relationships with government organizations, such as the Executive Office of Health & Human Services (EOHHS), the Centers for Medicare and Medicaid Services (CMS) and other external agencies as well as developing partnerships across all internal functions to ensure effective and compliant programmatic integration and execution.
In this mission-critical role, our Vice President represents the visions and values of BMCHP to the State and plays a leadership role across the company in representing and translating the needs of our key stakeholders into solutions.
Formulates business strategy for BMCHP’s D-SNP/SCO and MMP in collaboration with Senior Executives, including development of annual and multi-year business plans
Oversees execution of the D-SNP/SCO/MMP strategy in collaboration with a broad range of functional areas, including Finance, Network Management, Sales & Marketing, Clinical Affairs, Customer Service, Operations, Compliance and Quality Provides organizational leadership to all relevant departments to ensure that the D-SNP/SCO and MMP are competitive and that their value is understood to internal and external stakeholders
Develops a strong working partnership with EOHHS and CMS to advance the policy goals for the program and to advocate effectively for BMCHP as needed
Ensures that EOHHS and CMS have appropriate and expeditious access to people, data and other information as generally needed and as specifically requested
Provides organizational leadership in support of well integrated business processes across products and programs
In partnership with Sales & Marketing, develops, integrates and implements comprehensive marketing plans that support the growth of the D-SNP/SCO and MMP.
Works with Benefits Administration and Finance to ensure that benefit offerings and pricing maximize market opportunities for the D-SNP consistent with corporate objectives
Ensures Care Management structure and services meet programmatic and regulatory requirements and standards and provide optimal services to members
In coordination with Corporate Compliance, ensures compliance by our Plan and subcontractors consistent with contractual and regulatory state and federal requirements and other programmatic commitments
Evaluates program effectiveness and outcomes and employs data-driven decision-making to improve program performance
Assures the development and maintenance of the infrastructure and procedures in cooperation with functional areas to promote the optimal performance of the D-SNP/SCO and MMP
Oversees the personnel responsible for day-to-day operations of the D-SNP/SCO/MMP business. Maintains effective relationships and lines of communications with managers who directly supervise personnel who work in or support the program business to ensure successful operations and avoid conflict
Bachelor’s degree required and Master’s degree in business or health care is strongly preferred
Minimum ten years of progressive experience in health care or managed care environment
Significant experience in Medicare and Medicaid programs
Proven track record of health care policy and/or health plan leadership and development
Demonstrated experience in strategic planning and product development and management
Demonstrated experience in working with government officials and other external stakeholders including providers, consumer groups and/or other groups served by public benefit programs
Experience in overseeing, managing or supporting at a leadership level a D-SNP or MMP Plan preferred
Competencies, Skills, and Attributes:
Ability to manage up, down and across as a part of a larger matrix organization
Demonstrated leadership skills and proven ability to lead and motivate employees
Innovative thinker and able to articulate vision and mission of the organization
Exceptional communication and collaboration skills
Proven ability to effectively build and manage teams
A belief in evidence-based research and scientific decisions relative to health care coverage
Passion for the member population served
*Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.
Internal Number: 292842
About BMC HealthNet Plan
BMC HealthNet Plan is a non-profit managed care organizations committed to providing the highest quality healthcare coverage to underserved populations. In Massachusetts, BMC HealthNet Plan is the business name for Boston Medical Center Health Plan, Inc.; outside Massachusetts, Well Sense Health Plan is the business name.