The Vice President, Archcare Advantage is responsible for The Catholic Needs Plan, LLP d/b/a Archcare Advantage ( CSNP ) which is a comprehensive risk based health maintenance organization ( HMO ) organized under Article 44 of the Public Health Law. The Vice President will have the responsibility of managing business strategies which includes risk adjustment management and membership satisfaction and growth. Additional responsibilities are the management of utilization review, care management / quality, medical management, revalidation audits, compliance, and regulatory audits. The Vice President must have a thorough understanding of Medicare Advantage.
- Generate initiatives that will lead to in improved enrollment, customer retention, improved competitive positioning and increased customer and earnings growth by the creation of strong brand reputation in the marketplace and within our programs.
- Manage performance of Archcare Advantage to meet membership, earnings and quality targets.
- Create and manage contracts and reimbursement approaches to match provider network improving measureable performance and the quality of care for health plan customers.
- Improve and maintain relationships to optimize total medical cost and position the market and matrix partners for growth opportunities.
- Establish the business goals for essential functions that impact Archcare s business performance. This including contracting, population health, provider performance management, operations, risk adjustment, and medical cost management.
- Inspire a collaborative culture while achieving industry leading customer scores.
- Forecast and evaluate changes in the external factors including state and federal government, identify effects and develop strategies to address.
- Negotiates product, price and services development to ensure value and competitiveness.
- Establish the business objectives for membership growth.
- Drive change leadership to best align the organization in a rapidly evolving industry and marketplace.
Bachelor s degree
Master s degree highly preferred
At least 7 years of upper management experience with Medicare Health Plans.
Experience with Medicare Advantage program
Experience with CMS at the strategic and tactical level
Extensive understanding of managing risk score.
Fully understands STAR rating process and experienced in moving plan toward a 5 star rating.
Experience with provider networks from reimbursement models to contracting and their impact on operations.
Fully understands regulatory requirements of a Medicare Advantage product.