Dual Special Needs Plan VP, BlueCare

Senior Executive Leader, BlueCare Plus D-SNP

We're looking for a proven leader who brings deep expertise in Medicare and Dual Special Needs Plans, along with a strong track record of driving financial performance, regulatory compliance, and operational excellence. This executive will be a strategic partner across the enterprise, capable of aligning cross-functional teams while navigating complex CMS and TennCare/Medicaid requirements.

In this role, you'll own the full Profit & Loss for the BlueCare Plus D-SNP business and set the strategic direction to ensure strong market positioning, member satisfaction, and operational efficiency. You will collaborate closely with Medicare and BlueCare leaders to align product strategy, oversee bid development and submission, and drive performance across Risk Adjustment and Stars initiatives. You'll also ensure audit readiness, contract compliance, and effective engagement with CMS and state partners, while leading high-performing teams and advancing network and revenue optimization strategies.

Success in this role means delivering sustainable financial performance, maintaining full regulatory compliance, and driving measurable improvements in quality and member outcomes—while building strong partnerships internally and externally to support long-term growth of the D-SNP line of business.

Ready to take the next step?

Note:

• This is a remote role with occasional travel within Tennessee, including BCBST's headquarters in Chattanooga.
• Sponsorship is not available for this role.
• Leadership at our organization is grounded in a strong commitment to AI-enabled transformation. We seek leaders who not only understand the strategic value of AI, but who actively champion its responsible adoption—embedding AI into decision-making, operations, and team workflows to drive innovation, scale, and measurable business impact.

Job 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

Job Qualifications

Education

• 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.

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.
• Experience in Financial or Operations management is preferred.

Skills/Certifications

• 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.
• Knowledge and experience in the use of financial and operations performance data and information as it pertains to members and providers is preferred.
• 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.