Sentara Health Plans provides health plan coverage to close to one million members in Virginia and Florida. We offer a full suite of commercial products including employee-owned and employer-sponsored plans, as well as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and Medicaid enrollees. We are seeking a dynamic and experienced Senior Vice President of Health Plan Operations to lead and oversee all operational aspects of our health plans. This critical leadership role will ensure efficient and effective delivery of services to our members, while driving continuous improvement and innovation.

Sentara Health Plans is part of a larger integrated delivery network, Sentara Health. Sentara Health is largest provider in the Commonwealth of Virginia and the combined entities generate approximately $14 Billion in annual revenues.

Position Summary:

Reporting directly to the President/CEO of the Health Plan, the Senior Vice President of Health Plan Operations is responsible for the strategic direction, operational execution, and financial performance of health plan operations, encompassing claims processing, enrollment, member services, member, provider call center and broker services, quality improvement, and regulatory compliance. This role requires a deep understanding of the managed care landscape, strong leadership skills, and a proven ability to drive operational excellence. This role is also responsible for the development, scaling, and execution of Claims and Health Plan operations focused on simplifying end-to-end customer experiences and business processes, while reducing operational expenses and risks leveraging a modern technology stack.

Key Responsibilities:

· Strategic Leadership: Develop and implement the strategic vision and operational plans for health plan operations, aligned with the organization's overall goals and objectives. Anticipate market trends and regulatory changes and proactively adapt operational strategies to maintain a competitive edge.

· Operational Excellence: Oversee the day-to-day operations of key departments, including claims processing, enrollment, member/provider call center/broker services, and regulatory compliance. Establish key performance indicators (KPIs) and drive continuous improvement initiatives to optimize efficiency, accuracy, and customer and associate satisfaction.

· Financial Performance: Manage the operational budget and ensure cost-effective resource allocation. Identify and deliver opportunities for cost savings and revenue enhancement, while maintaining high-quality service delivery.

· Risk Management and Regulatory Compliance: Implement governance structures to manage data exchanges and compliance with state and federal regulatory standards. Lead

initiatives to mitigate operational risks and ensure compliance with healthcare regulations and standards. Maintain up-to-date knowledge of regulatory requirements and implement necessary policies and procedures.

· Member Experience: Champion a member-centric culture and drive initiatives to enhance the member experience. Monitor member satisfaction and implement strategies to address their needs and concerns.

· Team Leadership: Lead, mentor, and develop a high-performing team of operational leaders and staff. Foster a positive and collaborative work environment that promotes innovation and professional growth.

· Technology & Innovation: Evaluate and implement innovative technologies to streamline operations, improve efficiency, and enhance the member experience. Champion innovation and explore new approaches to service delivery.

· Cross-Functional Collaboration: Collaborate effectively with other departments, such as finance, marketing, and IT, to ensure seamless integration of services and achieve organizational goals.

Qualifications:

Education:

· Bachelor's degree in Business Administration, Healthcare Administration, or a related field; Master's degree preferred.

Experience:

· Minimum of 15 years of progressive experience in multi-market health plan operations, with at least 5 years in a senior leadership role.

· Deep understanding of the managed care industry, including regulatory requirements, claims processing, enrollment, member services, and quality improvement.

· Proven track record of driving operational excellence and achieving financial targets.

· Strong leadership skills, with the ability to motivate and develop high-performing teams.

· Excellent communication, interpersonal, and presentation skills.

· Experience with implementing and managing healthcare IT systems.

· Strong analytical and problem-solving skills.

· Ability to work effectively in a fast-paced and dynamic environment.

· Proven ability to work in highly complex and matrixed organizations.

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