Medicare Program Manager

Location

Fairfield, CA | United States

Job description

Reporting to the Chief Strategy and Government Affairs Officer, have responsibility for supporting leadership and staff in the development and launch of Partnership’s Medicare Dual Special Needs Plan (D-SNP) as well as the ongoing compliance and high-quality operational performance of staff and the program. To work cross functionally with stakeholders across the enterprise, supporting leadership and staff in the development and launch of Partnership HealthPlan’s Medicare Dual Special Needs Plan (D-SNP) as well as the ongoing compliance and high-quality operational performance of staff and the program.

Using project management skill set, this position will effectively communicate and implement project management methodologies to support operational planning, serve as a Medicare subject matter expert and, in collaboration with operational leaders, provide recommendations on process improvements and lead the program(s) to meet critical compliance and operational needs. Support the Chief Strategy and Government Affairs Officer (CSGAO) in leading and maintaining effective organizational structure for a Medicare D-SNP.

• Bring Medicare knowledge and experience, support PHC’s D-SNP operating model, and drive planning and implementation efforts.
• Support D-SNP development, planning, implementation and on-going efforts
• Serve as an internal subject matter expert (SME) and ensure readiness of D-SNP operational functions and performance (e.g., Marketing, Sales, Enrollment, Risk Adjustment, STARs).
• Analyze and monitor reports and dashboards to measure D-SNP performance and identify improvement opportunities.
• Identify D-SNP product opportunities based on analysis of PHC’s dual eligible population and the market landscape.
• Support internal work groups to manage the CMS Star Ratings program; support th execution of the annual CAHPS member survey, as well as drive efforts to enhance CAHPS results; collaborate with internal teams on execution, analysis, and adjustments related to the annual CAHPS member survey.
• Responsible for the project management of the bid submission process which includes acting as a liaison between internal stakeholders and external business partners to ensure timelines are met.
• Promote increased program efficiency, service levels, and value by capturing and monitoring performance, and then identifying opportunities for improvement and strategies to realize those opportunities.
• Identify D-SNP product opportunities based on analysis of PHC’s dual eligible population and the market landscape.
• Manage the annual Medicare/D-SNP plan benefit package design and bid filing with CMS, ensuring accuracy and timeliness of submissions as well as desk review inquiries.
• Manage and apply product development lifecycle to the application process, bid development, benefit designs, member materials, and go-to-market strategy.
• In collaboration with our Marketing & Communications function, provide centralize year-round support in Medicare for the development and editing of core beneficiary communications, to include the Medicare Summary of Benefits and Annual Notice of Change/Evidence of Coverage for print and online distribution, ensuring compliance with CMS guidelines.
• Collaborate with Compliance and other departments to ensure PHC is appropriately addressing relevant program requirements, i.e., those distributed through ongoing Regulatory Change Management (RCM) memos and the annual CMS Call Letter; coordinate and ensure all necessary CMS and state reporting for the D-SNP program coming from various teams are timely.
• Identify opportunities to increase efficiency, improve service levels and to ensure regulatory compliance through enhanced operations with team members.
• Build and maintain collaborative working relationships internal stakeholders, vendors, and other team members involving all phases of project.
• Support CSGAO in leading and maintaining effective organizational structure for a Medicare D-SNP.
• Other duties as assigned.

Bachelor’s Degree or equivalent combination of education/experience. Master’s degree preferred. Five (5) or more years’ experience in product development, process improvement and/or product management, ideally within a Medicare environment. Three (3) or more years of project management (2) or more years’ experience developing or implementing operational Medicare components.; or an equivalent combination of education and experience.

Highly proficient in applicable business software applications including PC usage, Microsoft Word, PowerPoint and Excel. Knowledge of Policy development. Preparation of business plans, analyses, financial projections, and programmatic and operational reports. Knowledge of state and federal managed care program requirements, including Medi-Cal and Medicare health care laws. Research and program planning methodology. Project Management. Excellent public speaking skills and highly skilled in written communication. Valid California driver’s license and proof of current automobile insurance compliant with PHC policy are required to operate a vehicle and travel for company business.

Ability to evaluate plan performance. Develop and execute strategic business initiatives. Perform policy development and implementation in the areas of Medicare and Medi-Cal. Conduct compliance and regulatory-related research and analysis to support decision-making and planning for major strategic initiatives. Communicate effectively, both verbally and in writing. Perform Project Management activities.

Ability to use a computer keyboard and other business machines. More than 50% of work time is spent in front of a computer monitor. When required, ability to move, carry, or lift objects of varying size, weighing up to 35 lbs.

All HealthPlan employees are expected to:

• Provide the highest possible level of service to clients;
• Promote teamwork and cooperative effort among employees;
• Maintain safe practices; and
• Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.

HIRING RANGE:

$ 120,686.00 - $ 156,735.06

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.

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