• Director, Individual Marketplace

    Job Locations US-VA-Glen Allen
    Job ID
    2018-4637
  • Overview

    The Director, Individual Marketplace will ensure the effectiveness of implementation and operational activities related to the organization’s Individual Marketplace products.  This role works closely with the Compliance team to ensure that all operational activities are compliant with both state and federal requirements.  Additionally this position will oversee the annual filing and bid process as well as product strategy and delegated entity relationships.   Located in Richmond, VA this opportunity offers relocation assistance.

    Responsibilities

    • Oversees annually the development of Individual Marketplace filings and bid, which includes financial analysis, benefit design, and marketing strategy in conjunction with product leadership.
    • Oversees product operations to ensure that performance is consistent with the Centers for Medicare and Medicaid Services (CMS) regulatory requirements. Works closely with the operational areas responsible for care coordination, grievance and appeals, and quality to ensure effectiveness and compliance.
    • In conjunction with Program leadership, helps to lead the organization in the implementation and operationalization of Individual Marketplace products.
    • Establishes workgroups and works closely with the operational areas to inform them of new requirements and changes to existing requirements. Provides functional and technical support regarding Individual Marketplace product requirements.
    • Assists the operational areas with the implementation of new requirements.
    • Collaborates with operational departments to effectively oversee projects, identify resources, resolve issues and mitigate risks.
    • Develops, implements, and manages the adoption of controls that allow the organization to quickly identify trends ad potential issues and address them in a timely manner.
    • Develops effective reporting tools to monitor operational functions and identify opportunities for improved performance. Tracks and reports product key performance indicators.
    • Keeps current with changing government regulations as it relates to the Individual Marketplace segment.
    • Fosters partnerships and develops relationships with CMS and the Virginia BOI (Bureau Of Insurance).
    • Oversees the timely filing of all submissions with the federal or state governments and ensures that all federal and state regulations and guidance are followed in the process.
    • Leads the planning, development and implementation of new benefits and benefit enhancements.

    Qualifications

      

    MINIMUM EDUCATION REQUIREMENTS

    • Bachelor's Degree
    • Master's Degree preferred

    WORK EXPERIENCE REQUIREMENTS

    • A minimum of five (5) years of experience in managed care operations, project management, business analysis experience, or related experience.
    • Significant operational management experience with Medicare or Individual Marketplace products required (e.g. On and Off Exchange, SHOP, Medicare Advantage).  Examples of acceptable work experience includes working within a health plan at the executive or operational management level, employment at a vendor company that has direct knowledge of health plan operations (e.g., operational support vendor such as a care management entity), or experience at a consulting firm with a sophisticated understanding of health plan operations.
    • Experience with CMS QRS and Risk Adjustment methodologies, as well as bid and application execution.
    • 3 to 5 years of supervisory experience.

    SPECIAL KNOWLEDGE AND/OR SKILLS

    • Proficient in Microsoft Office computer applications such as Excel, Outlook, Word, and Power Point.
    • Previous experience as a lead in a functional area, managing cross functional teams.
    • Experience leading cross functional business teams.
    • Strong analytic skills.
    • Exceptional written, verbal and presentation communication skills.
    • Prior experience in managed care required.
    • Extensive knowledge of health plan operations and compliance programs.
    • Proven situational leadership skills and the ability to motivate and generate enthusiasm with individuals across all levels of an organization through ongoing organizational and industry change.
    • Proven ability to drive performance in a matrix environment working across all departments.
    • Significant and sustained project management experience that includes interacting with and presenting to senior-level executives.
    • Commitment to working in a team environment with an emphasis on partnering and sharing work with colleagues.
    • Superior problem solving and analytic skills with the capability of applying knowledge outside of one’s immediate functional area.

    PHYSICAL REQUIREMENTS

    • Physical health sufficient to meet the ergonomic standards and demands of the position

    About Us

    Virginia Premier is a managed care organization which began as a full-service Medicaid MCO in 1995. Partnered with VCU Health Systems we strive to meet the needs of the underserved and vulnerable populations in Virginia by delivering quality driven, culturally sensitive and financially viable Medicare and Medicaid healthcare programs.  Headquartered in Richmond, VA we also have offices in Roanoke, Tidewater and Bristol with additional satellite locations allowing us to serve over 200,000 members across eighty counties throughout Virginia. 

     

    We offer competitive salaries and a comprehensive benefits package to include excellent Medical, Dental and Vision Plans, Tuition Assistance, Infant-At-Work Program, Remote Work options and generous vacation and sick leave policies. Our culture supports an environment where employees can continuously learn and gain professional growth through various development programs, education, exciting projects and career mobility.  

     

    All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE

     

    Our mission is to inspire healthy living within the communities we serve!

    Options

    Sorry the Share function is not working properly at this moment. Please refresh the page and try again later.
    Share on your newsfeed

    Need help finding the right job?

    We can recommend jobs specifically for you! Click here to get started.