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