Vice President, Operations

Centene Management Company•Latham, NY

18d

About The Position

Centene is transforming the health of our communities one person at a time. As an Executive on our team, you could be the one who changes everything for our 28 million members. Position Purpose: Oversee operations, procurement opportunities, new product implementations and initiatives for assigned business unit or product line to meet strategic objectives. Responsible for day to day operations of assigned business unit or product line ensuring product strategy developed and key priorities are implemented. Execute projects and activities to ensure health plans are meeting all product goals. Provide day to day oversight of assigned business unit or product line. Collaborate with multiple stakeholders and business unit leadership to establish strategic vision, operational objectives, and policies and procedures ensuring compliance with state and federal contracts, related laws, regulations and executive orders. Deep understanding of managed care models (HMO, PPO, Medicaid, Medicare Advantage, Duals, SNPs). Familiarity with healthcare laws, reimbursement models, and value-based care initiatives. Perform duties as senior liaison between product line, other business units, corporate, and external stakeholders related to operational areas. Oversee day-to-day operations including claims processing, provider network management, member services, utilization management, and quality improvement. Ensure compliance with CMS, NCQA, HIPAA, and other regulatory bodies. Oversee implementation and optimization of health plan operations systems (e.g., claims adjudication platforms, CRM tools). Drive digital transformation initiatives to streamline operations. Understand and execute on key operational needs of assigned business unit or product lines. Oversight of relevant corporate business units to ensure the development and implementation of operational work processes and systems within product lines to senior management. Act as lead on new product implementations.

Requirements

Bachelor's Degree in Business Administration, Healthcare Administration, or related field required.
8+ years of operations, management, or administration experience in the Healthcare or Insurance industry required.
Deep understanding of managed care models (HMO, PPO, Medicaid, Medicare Advantage, Duals, SNPs).
Familiarity with healthcare laws, reimbursement models, and value-based care initiatives.

Nice To Haves

Experience with business development and knowledge of legislative and/or regulatory processes preferred.

Responsibilities

Oversee operations, procurement opportunities, new product implementations and initiatives for assigned business unit or product line to meet strategic objectives.
Responsible for day to day operations of assigned business unit or product line ensuring product strategy developed and key priorities are implemented.
Execute projects and activities to ensure health plans are meeting all product goals.
Provide day to day oversight of assigned business unit or product line.
Collaborate with multiple stakeholders and business unit leadership to establish strategic vision, operational objectives, and policies and procedures ensuring compliance with state and federal contracts, related laws, regulations and executive orders.
Perform duties as senior liaison between product line, other business units, corporate, and external stakeholders related to operational areas.
Oversee day-to-day operations including claims processing, provider network management, member services, utilization management, and quality improvement.
Ensure compliance with CMS, NCQA, HIPAA, and other regulatory bodies.
Oversee implementation and optimization of health plan operations systems (e.g., claims adjudication platforms, CRM tools).
Drive digital transformation initiatives to streamline operations.
Understand and execute on key operational needs of assigned business unit or product lines.
Oversight of relevant corporate business units to ensure the development and implementation of operational work processes and systems within product lines to senior management.
Act as lead on new product implementations.