Senior Vice President – Managed Care

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🔥 2 minutes ago

🌴 South Carolina – Remote

🌴 South Carolina – Remote

💵 $175k - $250k / year

⏰ Full Time

🟠 Senior

👔 Vice President

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TRISTAR Insurance Group

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1987

💼 Consulting

🏥 Healthcare

📦 Logistics

Consulting • Healthcare • Logistics

TRISTAR Insurance Group is a national third-party administrator (TPA) that provides insurance administration and risk management services to employers, insurers and public entities. Its solutions include property & casualty, workers' compensation, general and auto liability, managed care (bill review, case management, utilization review, nurse triage, pharmacy benefit management), absence and disability management, employee group benefits administration, and risk control and workplace safety services. TRISTAR emphasizes collaborative, technology-enabled and tailored services to transform risk into opportunity for its clients.

📋 Description

• Develop and execute the strategic vision for the Managed Care division • Provide executive leadership and operational oversight for Medical Management, Bill Review, Pharmacy Benefit Management, Ancillary Services, Provider Networks, and related operations • Establish, monitor, and report on operational, financial, client savings, service quality, and productivity metrics • Analyze performance to improve client outcomes, revenue growth, margins, efficiency, and scalability • Develop and continuously improve policies, processes, best practices, and management methods • Lead organizational planning, budgeting, forecasting, capital planning, and resource allocation • Build, mentor, and develop leadership teams through coaching, succession planning, talent development, and performance management • Establish and maintain strategic relationships with vendors, provider networks, business partners, consultants, prospects, and clients • Negotiate vendor and partner agreements and oversee service-level, financial, regulatory, and contractual performance • Ensure compliance with federal, state, industry, accreditation, contractual, and internal requirements • Partner with Sales, Business Development, Client Services, Marketing, Finance, Information Technology, Compliance, Legal, and Operations • Support sales and client-facing efforts through presentations, finalist meetings, RFPs, client strategy sessions, conferences, and C-suite presentations • Present operational performance, financial results, strategic initiatives, and recommendations to executive leadership and the Board of Directors • Identify market trends, emerging technologies, regulatory developments, and competitive opportunities • Lead enterprise-wide process improvement, automation, technology implementation, and operational transformation initiatives • Communicate and reinforce the Company’s mission, vision, values, and culture • Perform other duties and special projects assigned by the President

🎯 Requirements

• Bachelor’s degree required; master’s degree preferred • 15 or more years of progressively responsible leadership experience • Experience emphasizing operational performance, employee management, financial accountability, and business growth • Proven track record improving operations, increasing revenue, managing budgets, and leading a $30–60M business • Progressive experience in insurance services, managed care, or a related business sector • Strong knowledge of statutory regulations, managed care services, vendor management, contract negotiation, and customer service delivery • Experience overseeing direct and indirect reports, including remote teams • Ability to manage a full suite of customer services, including ongoing maintenance and issue resolution • Exceptional written and verbal communication skills • Experience presenting to C-suite audiences, Boards of Directors, prospects, clients, and industry conference participants • Ability to travel approximately 10%–20%, including possible overnight, local, and out-of-state assignments • Proficiency with computers, laptops, standard office equipment, mobile devices, and office software

🏖️ Benefits

• Fully remote work option • Hybrid work at one of the company’s office locations preferred • Professional business attire appropriate for client meetings, presentations, conferences, in-office and virtual work • Occasional travel opportunities for client meetings, industry conferences, conventions, business development activities, vendor meetings, training sessions, and internal staff meetings