Vice President, Medicare Advantage Operations
Company: B.E. Smith
Location: Dallas
Posted on: January 26, 2023
Job Description:
Exciting Opportunity to Grow Health Plans at a Transformative
Healthcare Organization?The Position
- The Vice President, Medicare Advantage Operations will have
oversight for all major functions of the health plan, including
call center, eligibility, and enrollment, appeals and grievances,
claims, business solutions, claims operations, office management,
and vendor relationships of the Care N' Care (a Medicare Advantage
Health Plan).
- Reporting to the President of Care N' Care (a Medicare
Advantage Health Plan), this leader will oversee a team of Sr.
Directors, Directors, and additional staff totaling approximately
70 FTEs.
- The Vice President will work strategically with executive
leadership and across departments to ensure Medicare Advantage
operational functions align with mission-critical initiatives.
- Additional leadership areas include oversight of Care N' Care's
Third-Party Claims Administrator, Member Services programs, as well
as continual process and performance improvement. In partnership
with the Vice President, Medicare Sales, this leader will develop
strategies to increase plan membership year-over-year.
- Must bring 8+ years of Medicare Advantage operations
experience, as well as expert-level understanding of Medicare
Advantage compliance regulations and claims adjudication
processes.
- Bachelor's degree required. Master's degree preferred.The
Organization
- Care N' Care Insurance Co., started in 2008 by local
physicians, is a Medicare Advantage health plan based in the
Dallas-Fort Worth area that offers the traditional benefits found
in original Medicare plus additional benefits and services
- With more than 14,000 Medicare beneficiaries, Care N' Care
covers 13 counties in North Texas: Collin, Cooke, Dallas, Denton,
Erath, Hood, Johnson, Palo Pinto, Parker, Rockwall, Somervell,
Tarrant, and Wise.
- Care N' Care is a wholly owned subsidiary of Southwestern
Health Resources (SWHR), a joint venture partnership formed by UT
Southwestern and Texas Health Resources, two of the country's
largest healthcare systems. SWHR creates connections that provide
value to its network providers, strengthen the patient-physician
experience, improve health outcomes and the total cost of care
across the healthcare delivery system. The organization's work is
focused on creating value, and that means providing patients with
the right care, at the right time, and in the right place.
- With over 6,000 physician and ancillary providers and 29
hospital locations in its network, SWHR connects physicians to
patients and insights to outcomes - identifying barriers to better
population health management and relentlessly pursuing a new model
of value-based, high-quality, data-driven healthcare.
- Learn more about Care N' Care: www.cnchealthplan.com.The
Community
- Dallas-Fort Worth, Texas, is a modern metropolis of North Texas
and has no shortage of things to do and see; from Pritzker
Prize-winning architecture to innovative dining and memorable
entertainment, there's a little something for everyone to
enjoy.
- If culture is what you crave, Dallas has enough award-winning
Broadway productions, art-house theatres, comedy clubs, orchestral
experiences, and ballets to keep your interest peaked.
- Take an outdoor excursion to some great locations such as White
Rock Lake, Klyde Warren Park, Katy Trail, or Dallas Arboretum.
- From The Sixth Floor Museum and Dealey Plaza to the West End
and Southfork Ranch, the city offers an array of historical sites
to visit, explore, and learn
from.#BESmith#BESrecruitment#LI-GH1
Keywords: B.E. Smith, Dallas , Vice President, Medicare Advantage Operations, Executive , Dallas, Texas
Didn't find what you're looking for? Search again!
Loading more jobs...