VP, Medicare Strategy & Operations

Blue Cross and Blue Shield of Louisiana•Baton Rouge, LA

1d•Onsite

About The Position

Provide executive leadership for the Medicare Advantage (MA) program, owning end-to-end performance across strategy, operations, and financial outcomes. This role drives results across product design, regulatory compliance, quality (Stars), risk adjustment, and member experience, while partnering across a highly matrixed organization to achieve enterprise goals.

Requirements

Bachelor’s degree in Business, Healthcare Administration, or related field required
10+ years of progressive experience in healthcare or health insurance
5+ years in health plan operational leadership
Significant experience in Medicare Advantage required
Experience in MA product strategy, operations, Star Ratings, quality, and/or risk adjustment
Demonstrated success leading large, cross-functional initiatives in a matrixed environment
Deep knowledge of Medicare Advantage operations, regulatory requirements, and market dynamics
Proven ability to drive performance across financial, quality, and operational metrics
Strong strategic thinking and analytical capabilities
Executive presence with the ability to communicate effectively with senior leadership and the Board
Ability to influence without direct authority across matrixed teams
Experience leading complex programs, systems, or large-scale initiatives
Strong relationship-building and stakeholder management skills

Nice To Haves

Master’s degree (MBA, MPH, or equivalent) preferred
Relevant experience may substitute for education
PMP or similar certification preferred

Responsibilities

Own the full lifecycle performance (P&L) of the Medicare Advantage business, ensuring financial sustainability and market competitiveness.
Develop and execute MA strategy, including product design, benefit structure, and market positioning aligned to enterprise priorities.
Drive performance across key metrics including Star Ratings, risk adjustment, HEDIS®, member satisfaction, and retention.
Lead cross-functional execution across shared services (e.g., claims, medical management, network, finance, IT) through influence and governance structures.
Ensure compliance with CMS, state, and BCBSA requirements, proactively adapting to regulatory changes.
Establish and monitor operational dashboards; identify risks and implement corrective actions to achieve performance targets.
Partner with analytics, quality, and risk adjustment leaders to define and execute improvement strategies.
Support bid development and annual planning processes to align financial, operational, and market objectives.
Provide executive-level reporting and insights to senior leadership and the Board.
Build and lead high-performing teams, fostering a culture of accountability, continuous improvement, and service excellence.