AVP, Chief Medicare Officer - Georgia Gulf States
Core
Lead market performance, cost structure, and local execution of medical costs management, compliance, and revenue integrity for Medicare Advantage products in the Southeast US.
Role type
Senior Vice President, Chief Medicare Officer (Market Leader)
Builds
Medicare Advantage plans (IVL/DSNP) and Employer Group products
Domain
Health Insurance / Medicare Advantage / US Southeast
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Medicare Advantage operations leadership, P&L management, insurance regulatory compliance, value-based provider contracting, strategic market planning, team leadership, cross-functional partnership
Preferred skills
None explicitly stated
Technologies
None explicitly stated
Responsibilities
Drive short- and long-term growth and profitability for the Medicare business; Lead implementation of new contracts, programs, and services; Account for plan financial performance and budget achievement; Provide strategic leadership to senior functional leaders across operations, sales, marketing, provider relations, network development, utilization management, quality, and revenue integrity; Ensure alignment and integration across business functions and corporate partners; Lead development of policies and procedures for state and federal compliance; Oversee plan readiness and performance for audits; Direct and coordinate Medicare business operations; Monitor financial performance and implement corrective actions; Build and develop high-performing teams; Partner to drive strategic initiatives and elevate decisions to executive leadership; Develop and execute sustainable growth strategies; Collaborate on monthly performance reviews and bid execution.
Seniority
Senior, hands-on IC with market leadership