What are the responsibilities and job description for the Senior Vice President - Managed Care position at TRISTAR MANAGED CARE INC?
This is a remote position but hybrid at one of our office locations would be preferred.
POSITIONS SUPERVISED: Medical Management, Bill Review, Pharmacy Benefit Management (PBM), Ancillary Services, and other Managed Care operational leaders
POSITION SUMMARY:
The Senior Vice President of Managed Care provides executive leadership and strategic direction for all Managed Care operations. As a member of the Executive Leadership Team, this role develops and executes strategies that drive operational excellence, enhance client outcomes, improve financial performance, and support sustainable organizational growth. The SVP is responsible for the overall leadership and performance of the Managed Care division, including oversight of managed care programs, operational performance, quality initiatives, regulatory compliance, and vendor partnerships. This position ensures the delivery of innovative, cost-effective, and high-quality managed care solutions while maintaining alignment with the Company's strategic objectives and commitment to exceptional client service. Working collaboratively with executive leadership, the SVP shapes long-term business strategy, identifies opportunities for innovation and operational improvement, and implements initiatives that maximize profitability, improve efficiency, and deliver measurable value to clients. The role also oversees strategic vendor relationships, ensuring service quality, contractual compliance, and cost-effectiveness while supporting the Company's continued growth and competitive position within the industry.
DUTIES AND RESPONSIBILITIES:
- Develop and execute the strategic vision for the Managed Care division, ensuring alignment with Company objectives, long-term growth plans, and profitability goals.
- Provide executive leadership and operational oversight for Managed Care functions, including Medical Management, Bill Review, Pharmacy Benefit Management (PBM), Ancillary Services, Provider Networks, and related business operations.
- Establish, monitor, and report on key performance indicators, operational metrics, financial results, client savings, service quality, and productivity trends.
- Analyze operational and financial performance to identify opportunities for improved client outcomes, revenue growth, margin performance, efficiency, and scalability.
- Develop, implement, and continuously improve policies, processes, best practices, and management methods that support compliance, workflow optimization, customer satisfaction, and return on investment.
- Lead organizational planning, budgeting, forecasting, capital planning, and resource allocation for the Managed Care division.
- Build, mentor, and develop high-performing leadership teams through coaching, succession planning, talent development, performance management, and effective oversight of direct and indirect reports, including remote teams.
- Foster a culture of accountability, collaboration, inclusion, innovation, continuous improvement, and exceptional customer service.
- Establish and maintain strategic relationships with vendors, provider networks, business partners, consultants, prospects, and clients to ensure quality service delivery, contractual compliance, and cost-effective outcomes.
- Negotiate vendor and partner agreements and oversee performance against service levels, financial targets, regulatory requirements, and contractual obligations.
- Ensure compliance with applicable federal, state, and industry regulations, accreditation standards, contractual requirements, and internal policies.
- Partner with Sales, Business Development, Client Services, Marketing, Finance, Information Technology, Compliance, Legal, and Operations to support growth, client retention, and market positioning.
- Support sales and client-facing efforts by preparing and delivering written and verbal presentations that clearly demonstrate managed care capabilities, efficiency, accuracy, measurable results, and value for prospects and clients.
- Participate in prospective client presentations, finalist meetings, Requests for Proposal (RFPs), client strategy sessions, conferences, and C-suite presentations.
- Present operational performance, financial results, strategic initiatives, and business recommendations to executive leadership and the Board of Directors.
- Identify market trends, emerging technologies, regulatory developments, and competitive opportunities that support innovation, operational transformation, and continued growth.
- Lead enterprise-wide initiatives involving process improvement, automation, technology implementation, and operational transformation.
- Communicate and reinforce the Company’s mission, vision, values, and culture throughout the Managed Care organization.
- Perform other duties and special projects as assigned by the President.
EQUIPMENT OPERATED/USED: Computer, laptop, printer, copier, scanner, fax machine, telephone, mobile devices, and other standard office equipment and software.
SPECIAL EQUIPMENT OR CLOTHING: Professional business attire appropriate for client meetings, presentations, conferences, in-office and virtual work.
TRAVEL: Occasional travel (approximately 10%–20%) is required for client meetings, industry conferences, conventions, business development activities, vendor meetings, training sessions, and internal staff meetings. Travel may include overnight stays and both local and out-of-state assignments as business needs require.
Qualifications:
QUALIFICATIONS REQUIRED:
Education/Experience, Skills and Abilities:
- Requires a bachelor’s degree; a master’s degree is preferred.
- Requires 15 or more years of progressively responsible leadership experience with emphasis on operational performance, employee management, financial accountability, and business growth. Must have a proven track record of improving operations, increasing revenue, managing budgets, and effectively leading a $30-60M business.
- Progressive experience in insurance services, managed care, or related business sector is required.
- Must demonstrate strong knowledge of statutory regulations, managed care services, vendor management, contract negotiation, and customer service delivery.
- Requires experience overseeing direct and indirect reports, including remote teams, and the ability to manage a full suite of services for customers, including ongoing maintenance and issue resolution.
- Exceptional written and verbal communication skills are required, including experience presenting to C-suite audiences, Boards of Directors, prospects, clients, and industry conference participants.
Mental and Physical Requirements: [see separate attachment for a copy of checklist of mental and physical requirements]
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MENTAL AND PHYSICAL REQUIREMENTS |
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1. MENTAL EFFORT
a. Reasoning development:
Follow one- or two-step instructions; routine, repetitive task.
Carry out detail but uninvolved written or verbal instructions; deal with a few concrete variables.
Follow written, verbal, or diagrammatic instructions; several concrete variables.
X Solve practical problems; variety of variables with limited standardization; interpret instructions.
X Logical or scientific thinking to solve problems; several abstract and concrete variables.
X Wide range of intellectual and practical problems; comprehend most obscure concepts. |
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b. Mathematical development:
Simple additional and subtraction; copying figures, counting, and recording.
X Add, subtract, multiply, and divide whole numbers.
X Arithmetic calculations involving fractions, decimals, and percentages.
X Arithmetic, algebraic, and geometric calculations.
Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination.
Highly complex mathematical and statistical techniques such as calculus, factor analysis, and probability determination; requires theoretical application. |
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c. Language development:
Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing.
Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; guide people and provide basic direction.
Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; interview job applicants.
X Ability to compose original correspondence, follow technical manuals, and have increased contact with people.
X Ability to report, write, or edit articles for publication; prepare deeds, contracts or leases, prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data. |
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2. PHYSICAL EFFORT
a. Physical activity required to perform the job:
X Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.
Light work: a. Exerting up to 20 pounds of force occasionally b. Exerting up to 10 pounds frequently c. Exerting a negligible amount of force constantly to move objects
(If the use of arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most of the time, the job is rated for Light Work).
Medium work: a. Exerting up to 50 pounds of force occasionally b. Exerting up to 20 pounds of force frequently c. Exerting up to 10 pounds of force constantly to move objects
Heavy work: a. Exerting up to 100 pounds of force occasionally b. Exerting up to 50 pounds of force frequently c. Exerting up to 20 pounds of force constantly to move objects
Very heavy work: a. Exerting in excess of 100 pounds of force occasionally b. Exerting in excess of 50 pounds of force constantly to move objects c. Exerting in excess of 20 pounds of force constantly to move objects
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Far vision: clarity of vision at 20 feet or more
Near vision: clarity of vision at 20 inches or less
X Mid-range vision: clarity of vision at distances of more than 20 inches and less than 20 feet
X Depth perception: the ability to judge distance and space relationships, so as to see objects where and as they actually are
Color vision: ability to identify and distinguish colors
Field of vision: ability to observe an area up or down or to the right or left while eyes are fixed on a given point
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2. PHYSICAL EFFORT (cont.) |
FREQUENCY |
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c. Physical activity necessary to perform the job and frequency (e.g., continually, frequently, or occasionally):
_ Climbing: Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like, using feet and legs and/or hands and arms. Body agility is emphasized. This factor is important if the amount and kind of climbing required exceeds that required for ordinary locomotion.
Balancing: Maintaining body equilibrium to prevent falling when walking, standing, or crouching on narrow, slippery, or erratically moving surfaces. This factor is important if the amount and kind of balancing exceeds that needed for ordinary locomotion and maintenance of body equilibrium.
Stooping: Bending body downward and forward by bending spine at the waist. This factor is important if it occurs to a considerable degree and requires full use of the lower extremities and back muscles.
Kneeling: Bending legs at knee to come to a rest on knee or knees.
Crouching: Bending the body downward and forward by bending legs and spine.
Crawling: Moving about on hands and knees or hands and feet.
Reaching: Extending hand(s) and arm(s) in any direction.
Standing: Particularly for sustained periods of time.
Walking: Moving about on foot to accomplish tasks, particularly for long distances.
Pushing: Using upper extremities top press against something with steady force in order to thrust forward, downward, or outward.
Pulling: Using upper extremities to extent force in order to drag, haul, or tug objects in a sustained motion.
Foot Motion: Using feet to push pedals.
Lifting: Raising objects from a lower to a higher position or moving objects horizontally from position to position. This factor is important if it occurs to a considerable degree and requires substantial use of the upper extremities and back muscles.
X Fingering: Picking, pinching, typing, or otherwise working with fingers rather than with the whole hand or arm as in handling.
Grasping: Applying pressure to an object with the fingers and palm.
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Occasionally
Occasionally
Frequently
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2. PHYSICAL EFFORT (cont.) |
FREQUENCY |
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X Talking: Expressing or exchanging ideas by means of the spoken word. Those activities in which workers must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly.
X Hearing: Perceiving the nature of sounds with or without correction. Ability to receive detailed information through verbal communication, and to make fine discriminations in sound, such as when making find adjustments on machined parts.
Feeling: Perceiving attributes of objects, such as size, shape, temperature, or texture by touching with skin, particularly that of fingertips.
X Repetitive Substantial movements (motions) of the wrists, hands, Motion: and/or fingers. |
Regularly
Frequently
Frequently
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3. WORKING CONDITIONS
Disagreeable job conditions to which the employee may be exposed and the frequency (e.g., continually, frequently, or occasionally) of this exposure.
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WORKING CONDITION ENVIRONMENTAL FACTOR |
NATURE/REASON OF EXPOSURE |
FREQUENCY |
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Dirt/Dust |
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Noise |
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Temperature extremes |
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Dampness |
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Vibrations |
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Equipment movement hazard |
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Chemicals/solvents |
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Electrical shock |
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Significant work pace/pressure |
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Odors/Fumes |
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Other (specify):
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Salary : $175,000 - $250,000