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INTRODUCTION

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 required
• Significant progressive leadership experience in health insurance or managed care, including responsibility for health plan product strategy, development, integration or portfolio performance required
• Demonstrated ability to lead complex, cross-functional product decisions and translate business, policy and market developments into operational and financial action required
• Experience working across health plan Finance/Actuarial, Clinical, Network, Operations, Sales and related functions, with strong knowledge of government-sponsored managed care required
• Demonstrated ability to influence senior leaders, evaluate product economics, interpret performance data and guide significant product improvements required
• Experience leading and developing professionals or cross-functional teams in a complex organization required
• 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 required
• 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 required
• Strong health plan product-management discipline, strategic planning, financial acumen and understanding of member and market needs required
• Ability to address complex, multidimensional challenges and build alignment across functions with differing priorities required

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.