Overview
Provides strategic leadership for an assigned VNS Health Plans product portfolio, with responsibility for product direction, development, integration and performance. Translates market, member, policy and financial insights into a coordinated product strategy and works across clinical, operational, network, sales, community and other functions to ensure the product is competitive, responsive to the populations served and operationally sustainable.Leads a distinct Medicare or Medicaid/Managed Long Term Care (MLTC) product function, develops and implements short- to medium-term plans, guides significant product decisions and serves as a senior advisor on the implications of product and policy changes. Collaborates closely with the counterpart product leader to align strategies across government-sponsored programs, including populations with overlapping Medicare and Medicaid needs.
Qualifications
Pay Range
USD $193,600.00 - USD $258,200.00 /Yr.
About Us
VNS Health has been committed to meeting the needs of New Yorkers for over 130 years. We’re one of the largest nonprofit home- and community-based health care organizations in the country, and today, more than 11,500 team members work together to make a difference in the lives of more than 99,000 patients and members on any given day.
Provides strategic leadership for an assigned VNS Health Plans product portfolio, with responsibility for product direction, development, integration and performance. Translates market, member, policy and financial insights into a coordinated product strategy and works across clinical, operational, network, sales, community and other functions to ensure the product is competitive, responsive to the populations served and operationally sustainable.Leads a distinct Medicare or Medicaid/Managed Long Term Care (MLTC) product function, develops and implements short- to medium-term plans, guides significant product decisions and serves as a senior advisor on the implications of product and policy changes. Collaborates closely with the counterpart product leader to align strategies across government-sponsored programs, including populations with overlapping Medicare and Medicaid needs.
What You Will Do:
- Establishes and implements a one- to three-year strategy and operating priorities for the assigned product portfolio, aligned with Health Plans business, clinical, member and financial objectives.
- Leads product development, enhancement, positioning and lifecycle decisions; evaluate emerging market opportunities, program changes and member needs.
- Integrates product strategy with the implications for operations, provider network, clinical programs, sales, community engagement and member experience; influence functional plans without assuming direct management of those areas.
- Recommends product priorities and significant tradeoffs to Health Plans executive leadership, balancing competitiveness, member value, regulatory requirements, feasibility and financial sustainability.
- Establishes product performance expectations and partner with Finance, Actuarial and Analytics to assess membership, retention, revenue, margin, utilization, quality and experience measures.
- Leads cross-functional review of product results, identify root causes of performance gaps and direct development of corrective strategies and product improvements.
- Develops and presents business cases for product investments, benefit or program changes and growth opportunities, informing resource allocation and organizational decisions.
- Evaluates the operational and financial consequences of policy, benefit, network and service changes and recommend approaches that improve overall product performance.
- Provides senior product leadership across functional boundaries, establishing shared priorities, decision processes, implementation accountabilities and escalation paths for material product initiatives.
- Partners with Clinical, Operations, Network, Finance, Actuarial, Sales, Community, Technology, Compliance, Government Affairs and other stakeholders to translate product direction into executable plans.
- Serves as a senior advisor on assigned product strategy and represent the product function in leadership discussions and appropriate external engagements.
- Works in tandem with the counterpart Medicare or Medicaid product VP to coordinate decisions affecting dual-eligible populations, product transitions and the continuum of services.
- Leads and develops assigned product-management resources and capabilities, including performance expectations and talent development, consistent with the final approved organizational structure.
- Directs Medicare Advantage and applicable Special Needs Plan product strategy, benefit design, competitive positioning and ongoing portfolio optimization.
- Leads product-side planning and governance for the annual CMS bid and benefit cycle in partnership with Actuarial, Finance, Pharmacy, Clinical, Network, Operations and Compliance.
- Assesses Medicare policy, bid economics, market dynamics and member needs to guide benefit, service-area and product investment recommendations.
- Directs Medicaid and MLTC product strategy, including product integration, program development and alignment with long-term services and supports (LTSS) and complex member needs.
- Assesses New York State Medicaid and MLTC policy, contractual requirements, procurement opportunities and program changes; translate implications into product and cross-functional operational strategies.
- Guides product approaches to community needs, access, long-term care and the interaction between Medicaid and Medicare coverage for eligible populations.
- Participates in special projects and performs other duties as assigned.
Qualifications
Education:
Bachelor's Degree in Business, Healthcare Administration, Public Health, Finance or related field required
Master's Degree in Business, Healthcare Administration, Public Health, Finance or related field preferred
Work Experience:
- Minimum of ten years progressive managerial experience in health care administration, planning and financial oversight
- Significant progressive leadership experience in health insurance or managed care, including responsibility for health plan product strategy, development, integration or portfolio performance
- Demonstrated ability to lead complex, cross-functional product decisions and translate business, policy and market developments into operational and financial action
- Experience working across health plan Finance/Actuarial, Clinical, Network, Operations, Sales and related functions, with strong knowledge of government-sponsored managed care
- Demonstrated ability to influence senior leaders, evaluate product economics, interpret performance data and guide significant product improvements
- Experience leading and developing professionals or cross-functional teams in a complex organization
- Medicare assignment: Deep experience with Medicare Advantage product management, benefit design, CMS bid and regulatory processes, product economics and competitive market dynamics; Special Needs Plan experience strongly preferred
- Medicaid/MLTC assignment: Deep experience with New York State Medicaid and/or MLTC product strategy, LTSS, program and policy requirements, complex populations and the operational implications of state program changes
- Strong health plan product-management discipline, strategic planning, financial acumen and understanding of member and market needs
- Ability to address complex, multidimensional challenges and build alignment across functions with differing priorities
Pay Range
USD $193,600.00 - USD $258,200.00 /Yr.
About Us
VNS Health has been committed to meeting the needs of New Yorkers for over 130 years. We’re one of the largest nonprofit home- and community-based health care organizations in the country, and today, more than 11,500 team members work together to make a difference in the lives of more than 99,000 patients and members on any given day.
What You Will Do:
- Establishes and implements a one- to three-year strategy and operating priorities for the assigned product portfolio, aligned with Health Plans business, clinical, member and financial objectives.
- Leads product development, enhancement, positioning and lifecycle decisions; evaluate emerging market opportunities, program changes and member needs.
- Integrates product strategy with the implications for operations, provider network, clinical programs, sales, community engagement and member experience; influence functional plans without assuming direct management of those areas.
- Recommends product priorities and significant tradeoffs to Health Plans executive leadership, balancing competitiveness, member value, regulatory requirements, feasibility and financial sustainability.
- Establishes product performance expectations and partner with Finance, Actuarial and Analytics to assess membership, retention, revenue, margin, utilization, quality and experience measures.
- Leads cross-functional review of product results, identify root causes of performance gaps and direct development of corrective strategies and product improvements.
- Develops and presents business cases for product investments, benefit or program changes and growth opportunities, informing resource allocation and organizational decisions.
- Evaluates the operational and financial consequences of policy, benefit, network and service changes and recommend approaches that improve overall product performance.
- Provides senior product leadership across functional boundaries, establishing shared priorities, decision processes, implementation accountabilities and escalation paths for material product initiatives.
- Partners with Clinical, Operations, Network, Finance, Actuarial, Sales, Community, Technology, Compliance, Government Affairs and other stakeholders to translate product direction into executable plans.
- Serves as a senior advisor on assigned product strategy and represent the product function in leadership discussions and appropriate external engagements.
- Works in tandem with the counterpart Medicare or Medicaid product VP to coordinate decisions affecting dual-eligible populations, product transitions and the continuum of services.
- Leads and develops assigned product-management resources and capabilities, including performance expectations and talent development, consistent with the final approved organizational structure.
- Directs Medicare Advantage and applicable Special Needs Plan product strategy, benefit design, competitive positioning and ongoing portfolio optimization.
- Leads product-side planning and governance for the annual CMS bid and benefit cycle in partnership with Actuarial, Finance, Pharmacy, Clinical, Network, Operations and Compliance.
- Assesses Medicare policy, bid economics, market dynamics and member needs to guide benefit, service-area and product investment recommendations.
- Directs Medicaid and MLTC product strategy, including product integration, program development and alignment with long-term services and supports (LTSS) and complex member needs.
- Assesses New York State Medicaid and MLTC policy, contractual requirements, procurement opportunities and program changes; translate implications into product and cross-functional operational strategies.
- Guides product approaches to community needs, access, long-term care and the interaction between Medicaid and Medicare coverage for eligible populations.
- Participates in special projects and performs other duties as assigned.
Education:
Bachelor's Degree in Business, Healthcare Administration, Public Health, Finance or related field required
Master's Degree in Business, Healthcare Administration, Public Health, Finance or related field preferred
Work Experience:
- Minimum of ten years progressive managerial experience in health care administration, planning and financial oversight
- Significant progressive leadership experience in health insurance or managed care, including responsibility for health plan product strategy, development, integration or portfolio performance
- Demonstrated ability to lead complex, cross-functional product decisions and translate business, policy and market developments into operational and financial action
- Experience working across health plan Finance/Actuarial, Clinical, Network, Operations, Sales and related functions, with strong knowledge of government-sponsored managed care
- Demonstrated ability to influence senior leaders, evaluate product economics, interpret performance data and guide significant product improvements
- Experience leading and developing professionals or cross-functional teams in a complex organization
- Medicare assignment: Deep experience with Medicare Advantage product management, benefit design, CMS bid and regulatory processes, product economics and competitive market dynamics; Special Needs Plan experience strongly preferred
- Medicaid/MLTC assignment: Deep experience with New York State Medicaid and/or MLTC product strategy, LTSS, program and policy requirements, complex populations and the operational implications of state program changes
- Strong health plan product-management discipline, strategic planning, financial acumen and understanding of member and market needs
- Ability to address complex, multidimensional challenges and build alignment across functions with differing priorities