Senior Vice President - Managed Care

Tristar Insurance•Summerville, SC

3d•$175,000 - $250,000•Remote

About The Position

The Senior Vice President of Managed Care provides executive leadership and strategic direction for all Managed Care operations. As a member of the Executive Leadership Team, this role develops and executes strategies that drive operational excellence, enhance client outcomes, improve financial performance, and support sustainable organizational growth. The SVP is responsible for the overall leadership and performance of the Managed Care division, including oversight of managed care programs, operational performance, quality initiatives, regulatory compliance, and vendor partnerships. This position ensures the delivery of innovative, cost-effective, and high-quality managed care solutions while maintaining alignment with the Company's strategic objectives and commitment to exceptional client service. Working collaboratively with executive leadership, the SVP shapes long-term business strategy, identifies opportunities for innovation and operational improvement, and implements initiatives that maximize profitability, improve efficiency, and deliver measurable value to clients. The role also oversees strategic vendor relationships, ensuring service quality, contractual compliance, and cost-effectiveness while supporting the Company's continued growth and competitive position within the industry.

Requirements

Requires a bachelor’s degree; a master’s degree is preferred.
Requires 15 or more years of progressively responsible leadership experience with emphasis on operational performance, employee management, financial accountability, and business growth.
Must have a proven track record of improving operations, increasing revenue, managing budgets, and effectively leading a $30-60M business.
Progressive experience in insurance services, managed care, or related business sector is required.
Must demonstrate strong knowledge of statutory regulations, managed care services, vendor management, contract negotiation, and customer service delivery.
Requires experience overseeing direct and indirect reports, including remote teams, and the ability to manage a full suite of services for customers, including ongoing maintenance and issue resolution.
Exceptional written and verbal communication skills are required, including experience presenting to C-suite audiences, Boards of Directors, prospects, clients, and industry conference participants.
Requires logical or scientific thinking to solve problems; several abstract and concrete variables.
Requires arithmetic calculations involving fractions, decimals, and percentages.
Requires the ability to compose original correspondence, follow technical manuals, and have increased contact with people.
Requires sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time.
Requires near vision: clarity of vision at 20 inches or more.
Requires mid-range vision: clarity of vision at distances of more than 20 inches and less than 20 feet.
Requires depth perception: the ability to judge distance and space relationships, so as to see objects where and as they actually are.
Requires talking: Expressing or exchanging ideas by means of the spoken word. Those activities in which workers must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly.
Requires hearing: Perceiving the nature of sounds with or without correction. Ability to receive detailed information through verbal communication, and to make fine discriminations in sound, such as when making fine adjustments on machined parts.
Requires repetitive motion: Substantial movements (motions) of the wrists, hands, and/or fingers.

Nice To Haves

A master’s degree is preferred.

Responsibilities

Develop and execute the strategic vision for the Managed Care division, ensuring alignment with Company objectives, long-term growth plans, and profitability goals.
Provide executive leadership and operational oversight for Managed Care functions, including Medical Management, Bill Review, Pharmacy Benefit Management (PBM), Ancillary Services, Provider Networks, and related business operations.
Establish, monitor, and report on key performance indicators, operational metrics, financial results, client savings, service quality, and productivity trends.
Analyze operational and financial performance to identify opportunities for improved client outcomes, revenue growth, margin performance, efficiency, and scalability.
Develop, implement, and continuously improve policies, processes, best practices, and management methods that support compliance, workflow optimization, customer satisfaction, and return on investment.
Lead organizational planning, budgeting, forecasting, capital planning, and resource allocation for the Managed Care division.
Build, mentor, and develop high-performing leadership teams through coaching, succession planning, talent development, performance management, and effective oversight of direct and indirect reports, including remote teams.
Foster a culture of accountability, collaboration, inclusion, innovation, continuous improvement, and exceptional customer service.
Establish and maintain strategic relationships with vendors, provider networks, business partners, consultants, prospects, and clients to ensure quality service delivery, contractual compliance, and cost-effective outcomes.
Negotiate vendor and partner agreements and oversee performance against service levels, financial targets, regulatory requirements, and contractual obligations.
Ensure compliance with applicable federal, state, and industry regulations, accreditation standards, contractual requirements, and internal policies.
Partner with Sales, Business Development, Client Services, Marketing, Finance, Information Technology, Compliance, Legal, and Operations to support growth, client retention, and market positioning.
Support sales and client-facing efforts by preparing and delivering written and verbal presentations that clearly demonstrate managed care capabilities, efficiency, accuracy, measurable results, and value for prospects and clients.
Participate in prospective client presentations, finalist meetings, Requests for Proposal (RFPs), client strategy sessions, conferences, and C-suite presentations.
Present operational performance, financial results, strategic initiatives, and business recommendations to executive leadership and the Board of Directors.
Identify market trends, emerging technologies, regulatory developments, and competitive opportunities that support innovation, operational transformation, and continued growth.
Lead enterprise-wide initiatives involving process improvement, automation, technology implementation, and operational transformation.
Communicate and reinforce the Company’s mission, vision, values, and culture throughout the Managed Care organization.
Perform other duties and special projects as assigned by the President.