VP, Medicare Market Operations and Business Performance

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a VP, Medicare Market Operations and Business Performance in United States.

This executive leadership role is responsible for driving enterprise-wide Medicare Advantage market performance, ensuring strong financial outcomes, operational efficiency, and improved member experience across multiple regions. You will lead a data-driven performance management function that transforms complex operational, clinical, financial, and consumer insights into actionable strategies. The role requires close partnership with senior leaders across finance, actuarial, clinical operations, network, and analytics teams to identify performance gaps and implement high-impact interventions. You will play a central role in shaping Medicare market strategy, ensuring alignment between enterprise objectives and local execution. Operating in a highly matrixed and fast-paced environment, you will influence decisions at the highest level of the organization. This is a mission-critical role focused on scaling performance excellence and advancing Medicare Advantage outcomes nationwide.

• Lead enterprise oversight of Medicare market operational and financial performance across multiple geographies, ensuring alignment with growth, quality, and margin objectives.
• Drive accountability for membership growth, medical cost trends, risk adjustment, quality outcomes, and overall market profitability.
• Translate complex operational, financial, and clinical data into actionable insights and strategic performance improvement initiatives.
• Partner with finance and actuarial teams to manage Medical Loss Ratio (MLR), cost efficiency, and enterprise margin optimization.
• Identify market trends, utilization patterns, and performance gaps, and implement targeted interventions to improve outcomes.
• Align cross-functional priorities across enterprise teams to ensure consistent execution of Medicare strategy at the market level.
• Monitor competitive dynamics, regulatory changes, and demographic shifts impacting Medicare Advantage performance.
• Build and lead a high-performing team focused on Medicare market analytics, operational strategy, and performance governance.

Requirements

• Bachelor’s degree required; MBA, MHA, MPH, or related advanced degree strongly preferred.
• 15+ years of leadership experience in healthcare, health insurance, or Medicare Advantage operations.
• Deep expertise in Medicare Advantage market performance, operations, and regulatory frameworks.
• Proven track record of driving large-scale financial and operational performance improvements in complex, matrixed organizations.
• Strong experience leveraging advanced analytics to drive enterprise performance and strategic decision-making.
• Exceptional financial acumen with the ability to interpret and manage large-scale performance metrics.
• Strong executive communication and stakeholder influence skills with demonstrated ability to lead cross-functional alignment.
• Proven ability to lead organizational transformation and translate data into actionable business strategy.
• Deep understanding of Medicare reimbursement models, quality programs, and regulatory requirements.

Benefits

• Competitive executive compensation aligned with senior leadership responsibilities.
• Performance-based incentive compensation eligibility tied to enterprise and individual outcomes.
• Comprehensive medical, dental, and vision insurance coverage for employees and dependents.
• 401(k) retirement savings plan with employer contributions.
• Generous paid time off, including vacation, holidays, personal days, and caregiver leave.
• Life insurance, disability coverage, and additional executive-level wellbeing benefits.
• Remote work flexibility with occasional travel for leadership engagement and enterprise meetings.
• Opportunity to shape Medicare market strategy at scale and directly impact healthcare outcomes nationwide.