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VP Medicare & Individual

Hybrid | Eagan, Minnesota
Job ID: R0004336 Career Area: Executives Date Posted: 01/05/2024
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About Blue Cross

Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We’re committed to reinventing health care to improve health for our members and the community. We hope you'll join us.

How is this Role Important to Our Work?

The Vice President of Individual and Medicare owns the growth and revenue strategy and execution. Serves as an executive leader for Medicare and Individual, helping guide and support the organization’s overall direction. This executive will be a Market Leader that represents the IFP (Individual Family Plans) and Medicare business in the market and develop relationships that support growth, distribution, and partnership strategies.

This individual is accountable for the P&Ls of Medicare and Individual plans with a strong focus on achieving membership and operating margin performance. The VP will develop, execute, and manage the product strategy, end-to-end performance management, and overall strategic plan objectives for existing and future expansions of the Medicare markets and drive cross-enterprise influence to ensure risk adjustment strategic goals are delivered upon.

A Day in the Life:

  • Full P&L responsibility for Medicare and Individual markets, including attainment of profit and loss, revenue, membership enrollment and retention, market share, quality ratings (NCQA & STARs), medical and administrative expense targets, as well as member services SLAs, regulatory and compliance requirements for each market segment.

  • Develop and execute short- and long-term strategic plans that drive growth and performance of Medicare and Individual Markets. A main focus of role is to expand Medicare Advantage.

  • Influence activities for Star improvement and risk adjustment optimization to ensure that the maximum benefit is derived with minimized provider and member abrasion.

  • Foster strong local relationships (e.g. regulators, navigators/enrollment assistors). Maximize Medicare and Individual value proposition through partnerships with key matrix organizations (network, contracting, medical management, distribution, account management, product, etc.).

  • Collaborate with internal business functions (Finance, Actuarial, Quality & Member Experience, Population Health Management, Enrollment, Operations, Marketing, Provider Partnerships, Legal, IT, etc.) to execute on performance management and improvement initiatives for the Medicare markets. Jointly develop performance metrics with internal colleagues that help hold the organization accountable in a collaborative and productive manner.

  • Foster strong partnership with marketing and community relations teams to ensure adequate lead generation to drive sales, timely and effective communications with members and provider partners in line with CMS requirements and guidelines, and positive brand awareness building in order to promote active selection among eligible populations. Builds and maintains relationships with senior advocacy groups.

  • Communicates clearly and persuasively to build support for initiatives, engaging both internal and external stakeholders.

  • Manages and guides directs and the division toward accountable, goal-oriented outcomes aligned with enterprise strategy.

Nice to Have:

  • Demonstrated track record of ownership and achievement of bottom-line results by managing against well-crafted strategic plans.

  • Demonstrated experience leading/owning membership / financial forecasting.

  • Developed expertise of Contracting, Product, Provider Relations and Medical Management such that incumbent can leverage support needed to deliver the right customer solution.

  • Proven experience analyzing competitors' products, distribution systems, administrative and service capabilities as well as marketing plans and strategies to anticipate the market and external influences. Solutions-orientation with constant focus defining and executing on the “what” to strengthen and improve the business and assigned market performance.

  • Experience building positive relationships both internally and externally with a strong sense of self-initiative and desire to succeed.

  • Proven leadership, influencing and negotiation skills in a highly matrixed environment.

  • Must have strong analytical, communication, interpersonal and presentation skills.

  • Comfortable dealing with and managing in a constantly evolving, highly competitive industry and environment.

  • Able to make sound assumptions and is comfortable working in situations where data is incomplete or limited (problem solving).

  • Entrepreneurial thinking skills with strong customer focus and team orientation

Required Skills & Experience:

  • Minimum of a Bachelor's degree in business, healthcare, or related field equivalent experience.

  • 10 years in a market management, product management or segment strategy role, with at least 5 years in IFP, Medicaid, or Medicare.

  • 7 years owning and managing a P&L in healthcare or 5 years minimum P&L ownership in Medicare.and Individual.

  • 3 years market leadership within assigned market(s), strongly preferred in IFP and Medicare business with deep knowledge of Star/Quality and Risk adjustment programs. 

Make A Difference

Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.

Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to talent.acquisition@bluecrossmn.com.

All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.

Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association.
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