SVP, Medicare Products

Our Company

BrightSpring Health Services

Overview

This position is tasked with leading and growing the Medicare Advantage business for BrightSpring Health Services. They will manage the existing Institutional Special Needs Plan (I-SNP), while launching the Institutional Equivalent Special Needs Plan (IE-SNP) providing continuous evaluation for Medicare Advantage product expansion opportunities. The CEO is responsible for strategy and process advancement, development of the health plan team, execution of operations, identification and prioritization of market growth, and overall plan performance optimization to achieve key targets such as Membership, MLR%, and Quality measures. This is the highest-ranking employee of the division with ultimate responsibility for the plan's financial performance, health plan audits, regulatory compliance, policies and procedures, network development, and vendor relationships. Maintains a perspective on National health plan policies, and changes congruent with CMS regulations and the broader payer landscape.

Responsibilities

• Serves as a key leader and thought partner to advance the capabilities within BrightSpring Health Services
• Oversees all operations and business activities to ensure they produce the desired results and are consistent with the overall strategy and mission
• Leads Plan Bid development, pricing strategy, and Model of Care creation
• Manages relationships at both the State and Federal level
• Negotiates and manage existing vendor relationships, contracts, and monitoring of aligned outcomes; continuously seek new vendor and partner opportunities to improve performance
• Responsible for Delegation oversight and reporting
• Maintains audit readiness, by ongoing training, competency assessment, audit, monitoring of metrics and corrective actions
• Ensures forward-looking processes, planning, and assessments for product and network development growth and adequacy
• Directs TPA, PBM, Call Center and Member Experience
• Manages Sales Agents / Brokers, MAPD marketing & distribution strategies
• Oversees program and policy and procedure development to ensures compliance with current government and industry regulations
• Establishes effective quality management programming and reporting through the collection, aggregation and reporting of utilization management, care management and quality monitoring activities
• Plans and direct the development and delivery of training and educational programs for all department personnel.
• Leads and motivate team to advance employee engagement and to develop a high performing team
• Makes high-quality investing decisions to advance the business and meet MLR targets, and ensure that expenditures of the company are within the authorized annual budget of the Company
• Builds trust relations with key partners and stakeholders and act as a point of contact for important shareholders
• Provides oversight of markets; establish and implement the most effective strategies and approaches to meet clinical, strategic, and financial targets
• Reviews financial and non-financial reports to devise solutions or improvements

Qualifications

• Master's degree in Healthcare of Business Administration or an equivalent combination of education and/or additional job-related experience required
• Fifteen (15+) years in a senior or executive level
• Ten (10+) experience working in a health care delivery or payer organization with a least three (3) years in a managed care services and operations environment
• Proven track record of managing the implementation of business plans in a fast-track manner within complex markets
• Possess a level of working knowledge in a broad range of areas required to operate a healthcare business, including finance, clinical operations, marketing, sales, project management, technology, etc.
• Ability to work as part of a team
• Decision-making skills
• Leadership and management skills
• Ability to drive strategic direction
• Ability to communicate at all levels of the organization and work well in a team environment
• Oral and written communication skills
• Honesty and high integrity, with excellent interpersonal and conflict resolution skills
• Executive presence and high emotional intelligence
• Analytical and problem-solving skills
• Knowledge of CMS and state-based regulations.

About our Line of Business

BrightSpring Health Services provides complementary home- and community-based health solutions for complex populations in need of specialized and/or chronic care. Through the Company’s service lines, including pharmacy, home health care, and rehabilitation, we provide comprehensive and more integrated care and clinical solutions in all 50 states to over 475,000 customers, clients and patients daily. BrightSpring has consistently demonstrated strong and industry-leading quality metrics across its services lines, while improving the health and quality of life for high-need individuals and reducing overall healthcare system costs. For more information, please visit www.brightspringhealth.com. Follow us on Facebook, LinkedIn, and X.

Additional Job Information

Percentage of Travel:  25-75%