Clinical Operations & Physicians
VP Medicare Operations
Arlington, VA, United States

Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.

Are we growing? Absolutely--62% in year-over-year revenue growth through 2015. Are we recognized? Definitely. We’re 12th on Forbes’ list of America’s Most Promising Companies for 2015, one of “Becker’s 150 Great Places to Work in Healthcare” in 2016, and our CEO was number one on Glassdoor’s 2015 Highest-Rated CEOs for Small and Medium Companies. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.

What You’ll Be Doing

This is a senior Medicare leadership role, accountable for overall Operations and program execution

  • Optimize business performance through coordination of Provider Relations, Compliance, Finance, Vendor Management, Enrollment and Customer Service/Claims
  • Collaboration with the RAF team to increase risk scores for the plan
  • Collaboration with the Medicare Stars Team to increase ratings, year over year
  • Support the product strategy for the Medicare Advantage markets. Collaborate with Sales Leadership to train and sell product effectively and compliantly
  • Develop service area expansion plan for Medicare Advantage Plans, that insure profitable growth and access to care standards
  • Oversight of document creation for members within CMS guidelines (Evidence of Coverage, Annual Notice of Change and Summary of Benefits)
  • Lead a team that engages members and providers to close quality gaps and reduce medical expense
  • Breakdown complex operational issues in order to make effective decisions
  • Meet with clients to report on operational, quality and financial outcomes
  • Partner with Finance to forecast staffing needs and deliver on key productivity metrics
  • Work closely with Human Capital to assess individual performance and execute on a comprehensive talent development plan
  • Identify operational efficiencies to improve execution, reduce operating costs and standardize best practices across the organization


The Experience You Need (Required)

  • Bachelor’s degree; Master’s degree preferred
  • 10 years of leadership experience in a managed Care organization
  • 5 years of experience managing large, complex operations
  • 2+ years of Medicare experience


Finishing Touches (Preferred)

  • MBA or relevant advanced degree
  • Clinical experience
  • Provider experience
  • Medicare and Long Term Care
  • Experience designing and launching new, multifaceted programs
  • Ability to prioritize and manage multiple tasks simultaneously in a fast-paced environment
  • Proven record developing talent and building a high performing team
  • Ability to initiate and drive change
  • Demonstrated problem-solver
  • Strong interpersonal skills with ability to build relationships
  • Strong analytical skills; ability to quickly aggregate and analyze information and draw conclusions
  • Communicate effectively and succinctly
  • Experience creating professional presentations

Evolent Health is an Equal Opportunity/Affirmative Action Employer