Dual Special Needs Plan VP, BlueCare

BlueCross BlueShield of Tennessee•Chattanooga, TN

10d•Remote

About The Position

BlueCross BlueShield of Tennessee (BCBST) is seeking a Senior Executive Leader for BlueCare Plus D-SNP. This role requires deep expertise in Medicare and Dual Special Needs Plans, with a proven history of driving financial performance, regulatory compliance, and operational excellence. The executive will act as a strategic partner across the enterprise, aligning cross-functional teams and navigating complex CMS and TennCare/Medicaid requirements. The position owns the Profit & Loss for the BlueCare Plus D-SNP business, setting strategic direction for market positioning, member satisfaction, and operational efficiency. Key responsibilities include collaborating with Medicare and BlueCare leaders on product strategy, overseeing bid development and submission, and driving performance in Risk Adjustment and Stars initiatives. The role also ensures audit readiness, contract compliance, and effective engagement with CMS and state partners, while leading high-performing teams and optimizing network and revenue strategies. Success is measured by sustainable financial performance, full regulatory compliance, and measurable improvements in quality and member outcomes, supporting the long-term growth of the D-SNP line of business. This is a remote role with occasional travel within Tennessee. Sponsorship is not available. Leadership at BCBST is committed to AI-enabled transformation, seeking leaders who champion responsible AI adoption to drive innovation and business impact.

Requirements

Bachelor’s degree in business or a healthcare related field, or equivalent proven work experience required. Equivalent work experience is defined as four years of professional work experience.
8 years of progressively responsible management in Medicare health insurance products required with a minimum of 5 years in Medicare Advantage specific, with Dual Special Needs Plan experience preferred.
Experience in the management of P&L segment is required, direct responsibility for oversight of P&L is preferred.
Proven background in the development, implementation and/or administration of Medicare Advantage products is required.
Proven understanding of provider payment reimbursement methodologies in a Medicare Advantage environment is required, Medicaid experience preferred.
Proven strong leadership to direct a team to achieve high performance and goals.
Ability to understand the technical issues of healthcare financing and administration.
Proven leadership skills, superior communication and organizational skills.
Superior interpersonal, client relations, provider relations and problem-solving skills are essential.
Proven ability to conduct root cause analysis, plan, organize, and coordinate multiple projects.
Employees who are required to operate either a BCBST-owned vehicle or a personal or rental vehicle for company business on a routine basis will be automatically enrolled into the BCBST Driver Safety Program. The employee will also be required to adhere to the guidelines set forth through the program. This includes, maintaining a valid driver’s license, auto insurance compliance with minimum liability requirements; as defined in the “Use of Non BCBST-Owned Vehicle” Policy (for employees driving personal or rental vehicles only); and maintaining an acceptable motor vehicle record (MVR). The definition for "routine basis" is defined as daily, weekly or at regularly schedule times.

Nice To Haves

Dual Special Needs Plan experience preferred.
Experience in Financial or Operations management is preferred.
Knowledge and experience in the use of financial and operations performance data and information as it pertains to members and providers is preferred.

Responsibilities

Responsible for the Profit and Loss of the business segment
Provide strategic direction to senior management team to ensure operations support enterprise strategies, performance guarantees customer satisfaction and competitive positioning.
Collaborate with Medicare and BlueCare business leaders to ensure alignment across products and initiatives.
Oversee Medicare Dual Special Needs Plan products operations, including timely development and submission of the annual bid.
Ensure effective contract administration by projecting funding needs and negotiating budget settlements consistent with CMS funding and organizational requirements.
Drive achievement of required D-SNP performance measures in partnership with Corporate Quality, including audit readiness and reimbursement activities.
Monitor and interpret regulatory and program changes impacting Medicare products and ensure ongoing contract compliance, including fraud, waste, and abuse requirements.
Oversee implementation of product changes and maintain strong cross-functional partnerships to support operational, network, and enterprise objectives.
Build and maintain effective working relationships with CMS, TennCare and other federal and state bodies as it relates to the line of business.
Recruit, develop and lead a high-performing management.
Ability to travel as required