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VP, Market Leader - Medicare, Behavioral Health

Minor Outlying Islands, USA | Magellan Health

  • Industry:
    Healthcare - Hospitals
  • Position Type:
  • Functions:
    Business Development
  • Experience:
    10-12 years
Job Description:
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This position leads the Medicare member market as the subject matter expert and strategic visionary of Behavioral Health clinical care management for Medicare market members. Serves as the central point of contact to stakeholders for acquisition and retention of key contracts and business. Supports the organization’s ability to acquire, build and manage customer relationships on Medicare products and services. Responsible for the, oversight, maintenance and growth of business line, and is responsible for setting a business plan that informs the company’s go to market strategy for the Medicare market utilizing defined leading clinical care management products / services and working with service areas to understand market requirements and ability to deliver services. Liaison and key business partner between the Sales organization, Strategy, Shared Service Operations, Clinical Center of Operational Excellence, Clinical Centers of Excellence, and the Medical Director. Responsible for achieving business objectives and goals, helping to cultivate and foster relationships with current and new customers in the Medicare market, and collaborating with other service areas of the organization, to confirm effective delivery of defined services.

Sets and executes strategic vision and objectives for the Medicare market using market analysis and industry trends.

Develops and implements long-term strategic initiatives focused on achieving operational excellence in the Medicare market.

Collaborates with Behavioral Health Medical, Clinical and Shared Service Operations to effectively communicate capabilities, products, and solutions to new and potential Medicare customers to ensure ability to administer services effectively.

Ensures contract requirements are understood, communicated, and met; deliverables are accurate and delivered in a timely manner; participate in rate setting discussions.

Designs, develops, and implements programs in Medicare market focused on improving effectiveness, affordability, and quality of care.

Oversees the performance of Engagement and Care Management teams in a matrix reporting relationship alongside the Center of Operational Excellence Leads.

Assumes responsibility for growth, revenue, cost of care, operating gain, quality results and operational efficiency and effectiveness related to the Medicare business.

Consults with clinical stakeholders to develop improved utilization of effective and appropriate services, including effective member engagement strategies.

Collaborates with Care Management Lead, Engagement Operations Lead, Routine and Complex Care Management and Transition of Care Medicare Managers to ensure operational goals are aligned to Medicare’s strategic plan and vision.

Develops and implements action plans to improve performance and department outcomes, manage medical cost trends, and provide leadership periodic updates.

Provides leadership and expertise representing Medicare in new business activities (RFP responses, new market/product development, etc.) and upsell / cross-sell opportunities with existing clients.

Collaborates on the development and implementation of a staff plan, including learning and development strategy, in collaboration with the relevant Magellan leaders.

Anticipates and act on emerging healthcare trends to position the Medicare line of business for the future, in conjunction with other Magellan leaders.

Communicates clearly and persuasively to build support for initiatives, engaging Magellan stakeholders and other relevant system stakeholders.

Other Job Requirements


5 or more years of experience in professional practice

7 years post-degree (masters/doctoral) experience in behavioral health

7 years working with Medicare populations

Significant experience managing Medicare clinical operations

10+ years of experience in healthcare with a clinical and/or operations management focus.

10+ years of management level experience in the managed healthcare industry required.

Knowledge of government and CMS policies regarding Medicare eligibility, programs, and beneficiaries.

Knowledge of managed healthcare delivery systems to include critical components and interdependencies.

Knowledge of the variety of financial and clinical structures viable in the managed care arena.

Knowledge of clinical issues unique to the delivery of mental health and substance abuse services, of strategic planning

and the budget process.

Ability to communicate and advocate at the line through corporate staff levels.

Must possess strong analytical and organizational skills in a multiple site and function environment.

Proven ability to manage operations in a clinical healthcare system.

Strong negotiating and contracting skills.

General Job Information


VP, Market Leader - Medicare, Behavioral Health



Work Experience

Behavioral Health, Clinical, Management/Leadership


Bachelors: Behavioral Health (Required), Doctorate: Psychology, Masters: Behavioral Health, Masters: Business Administration, MD, PhD

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