Director, Medicare Programs

Sanford Health•Sioux Falls, SD

About The Position

Responsible for the performance, strategic leadership, product development and management, program direction and oversight of all functions and processes related to Sanford Health Plan (SHP) Medicare Programs. Ensures Medicare programs are leveraged as a strategic asset across the Sanford Health Enterprise.

Requirements

Bachelor's degree in health care, finance or a related field required.
Minimum of seven years' required experience working in health insurance operations with expertise or experience in: provider relations, provider back office operations, product, accounting/finance, compliance, or related fields.

Nice To Haves

Minimum of five years of government programs management experience preferred.
Minimum of five years related work experience or combination of seven years of transferrable experience and education in the areas of consulting, health plan operations, provider relations, or government programs preferred.

Responsibilities

Directs the day-to-day operations of the government programs department.
Develops and implements business plans, bids, and operational budgets that lead to achieving business goals and strategies.
Leads efforts to launch and operationalize Sanford's Medicare Advantage insurance products.
Manages and develops Medicare product portfolio to create an assortment of product offerings to optimize membership.
Works on complex compliance matters where analysis of issues, data and process require advanced specialist knowledge and in-depth industry and technical knowledge.
Develops and integrates improvements in health provider engagement, member engagement, health improvement programs, administrative excellence and data analytics.
Reviews department goals and objectives accordingly.
Drives quality performance through external data sources such as Centers for Medicare and Medicaid Services (CMS) star ratings and Healthcare Effectiveness Data and Information Set (HEDIS) to achieve goals and targets.
Provides guidance regarding emerging market opportunities to identify business threats, look for strategic solutions and develop strategies to address business issues and industry trends.
Investigates and leads government program product development with growth targets, strategic initiatives and service area expansions and execute new products and programs.
Drives the launch of new Medicare products, from inception through implementation, working with internal teams and external partners to ensure a successful implementation and go-to-market delivery.
Acquires and maintains professional expertise in, and promote effective understanding of government programs organizational requirements and government regulations.
Sets the vendor strategy to balance administrative costs with predicted medical cost.
Develops and maintains superior professional relationships with key stakeholders and internal functional areas designed to ensure program consistency and alignment of care management, network contracting and claims operations programs.
Maintains strong integration with health services division.
Possesses strong leadership capabilities and delegates responsibility accordingly.
Holds team accountable for meeting and exceeding established metrics and goals.
Maintains expert knowledge in different Medicare programs, such as Medicare Advantage Plans, Individual Special Needs Plans and Medicare supplemental plans.