Director of Medicare Product

$130,000 - $144,000/Yr

Metroplus Health Plan - New York, NY

Full-time - Senior

New York, NY

Professional, Scientific, and Technical Services

About the position

The Director of Medicare Product at MetroPlusHealth serves as the subject matter expert for all Medicare-related operations and compliance. This role is pivotal in ensuring that the organization adheres to federal and state regulations while developing and managing Medicare products. The director will coordinate interdepartmental processes, oversee annual Medicare bid submissions, and ensure that marketing and operational materials are compliant and effective. The position requires a strong understanding of the healthcare marketplace and the ability to lead initiatives that enhance service delivery and operational effectiveness.

Responsibilities

• Provide a resource to all operational departments regarding Medicare management.
• Communicate changes to Medicare management to all departments.
• Coordinate implementation of interdepartmental processes related to Medicare business.
• Assist the Regulatory Affairs Department with implementing mandated program changes.
• Assist with new program development and communications.
• Ensure appropriate and compliant marketing and operational materials are produced and distributed.
• Responsible for annual Medicare Bid submission ensuring Plan Benefit accuracy.
• Research and create market analysis for competitive benefit packages.
• Develop and monitor operational dashboards and KPIs for effectiveness and compliance.
• Perform root cause analysis to identify opportunities for improvement.
• Provide oversight of plan and vendor operations related to Medicare.
• Participate in medical cost discussions to maximize revenue and decrease costs.
• Coordinate efforts of consultants or internal work groups for Medicare program requirements.

Requirements

• A Bachelor's degree required; Master's degree preferred.
• Minimum 8 years of experience, including 5-7 years in a SME or leadership role in Administration or related fields.
• Thorough knowledge of organization, administration, and applicable regulations.
• 5-7 years of Medicare management and operations experience.
• Detailed knowledge of healthcare, specifically managed care and insurance regulations.
• Significant experience with Medicare, Medicaid, and Dual Eligible populations.
• Strong analytic and strategic planning skills.
• Exceptional written and oral communication skills.

Nice-to-haves

• Experience in Medicare managed healthcare or ancillary healthcare services industry.
• Demonstrated ability to analyze marketing challenges and determine initiatives.

Benefits

• Health insurance coverage
• Paid holidays
• Professional development opportunities
• Flexible scheduling options