Remote VP, Medicare Advantage & Managed Care

Vaco by Highspring; Tampa (FL); A distancia; USD 250.000 - 500.000; Jornada completa

Descripción de la vacante

Vaco by Highspring invites an accomplished healthcare executive to build and lead the organization's Managed Care function across Medicare Advantage (MAPD). The VP, Managed Care, reports to the CEO and will drive performance in Risk Adjustment, Utilization Management, and Care Management while ensuring regulatory compliance and quality outcomes.

This is a 100% remote role in the U.S. with a target to shape strategy, develop an integrated operating model, and lead a high-performing team across

Formación

• 10+ years of progressive healthcare leadership experience.
• Significant Medicare Advantage managed care experience.
• Leadership across at least two areas: Risk Adjustment, Utilization Management, Care Management, Population Health, Medical Management, Medical Economics, or Value-Based Care.
• Strong knowledge of CMS Medicare Advantage requirements.
• Demonstrated ability to improve clinical outcomes and financial performance.
• Experience leading complex clinical/managed care operations and cross-functional teams.
• Strong analytical, strategic, executive communication, and organizational leadership skills.
• Bachelor's degree required; master's degree strongly preferred.

Responsabilidades

• Set the strategy and operating model for Risk Adjustment, Utilization Management, and Care Management.
• Oversee UM programs, including authorization, utilization review, clinical appropriateness, and cost management.
• Lead care management and population health programs for high-risk, complex, and high-cost members.
• Integrate Risk, UM, and Care Management to identify opportunities to improve outcomes and plan economics.
• Partner with Finance, Actuarial, Analytics, Network, and Clinical teams to identify and reduce avoidable medical cost and utilization.
• Align managed care programs with Medicare Advantage quality/Stars objectives.
• Ensure CMS regulatory and audit readiness, including RADV.
• Establish executive dashboards, performance metrics, and ROI measurement.
• Build a high-performing organization and develop leaders, talent, processes, and infrastructure to support growth.

Descripción del empleo

Vaco by Highspring invites an accomplished healthcare executive to build and lead the organization's Managed Care function across Medicare Advantage (MAPD). The VP, Managed Care, reports to the CEO and will drive performance in Risk Adjustment, Utilization Management, and Care Management while ensuring regulatory compliance and quality outcomes.

This is a 100% remote role in the U.S. with a target to shape strategy, develop an integrated operating model, and lead a high-performing team across