Responsibilities

• Own overall Medicare growth strategy including membership, revenue, and market expansion targets.
• Lead relationships with contracted health plans including Anthem, Health Net, and Molina.
• Drive provider network alignment to support Medicare panel growth and performance.
• Partner with clinical leadership to design programs that improve outcomes and reduce cost of care.
• Oversee growth channels including broker strategy, community outreach, and member acquisition.
• Align internal teams including Provider Relations, Member Services, UM, and Marketing around Medicare priorities.
• Develop performance dashboards tracking growth, cost trends, retention, and quality metrics.
• Identify new opportunities including dual-eligible populations, special programs, and partnerships.
• Lead contracting and financial modeling discussions tied to Medicare risk and capitation strategies.
• Build and lead a high-performing Medicare growth team.

Requirements

• Minimum of 10 years of experience in a Medicare Advantage, MSO, IPA, delegated risk, or health plan environment.
• Demonstrated success driving Medicare Advantage membership growth and managing performance within risk-based reimbursement models.
• Strong knowledge of CMS regulations, Medicare Advantage plan operations, Star Ratings, quality programs, risk adjustment, and health plan economics.
• Experience collaborating with providers, health plans, physician organizations, and delegated entities to achieve operational and financial objectives.
• Proven ability to lead strategic initiatives while maintaining accountability for day-to-day operational execution in a fast-paced, growth-oriented environment.
• Excellent verbal, written, presentation, and interpersonal communication skills.
• Strong active listening, critical thinking, analytical, and problem-solving abilities, with the capacity to make sound decisions with minimal supervision.
• Demonstrated leadership skills, initiative, and the ability to influence, mentor, and support team and organizational success.
• Ability to establish credibility and build positive relationships with providers, health plan partners, members, and internal stakeholders through professionalism, confidence, and sincerity.
• Strong organizational, project management, time management, and prioritization skills, with the ability to manage multiple competing priorities and deadlines.

Preferred

• Master’s degree preferred