Medicare Program Manager

CenCal Health • Santa Barbara, CA

1d • $120,970 - $181,455

About The Position

The Medicare Program Manager provides essential program and operational support to CenCal Health CareConnect’s Dual Eligible Special Needs Plan (D-SNP). This role is responsible for leading, coordinating, and executing cross-functional operational initiatives that advance CenCal Health’s Medicare program. Core responsibilities include: Medicare Program Leadership & Strategy Execution Lead and support the operational execution of CenCal Health CareConnect’s D-SNP Medicare program by coordinating cross-functional initiatives that advance program viability, performance, and strategic goals. Cross-Functional Coordination & Governance Facilitation Serve as the central operational point of contact for Medicare governance bodies and D-SNP workgroups, including planning, facilitating, and supporting recurring meetings (e.g., Operations Meetings, Steering Committee) and ad hoc cross-functional forums. Program Management & Operational Oversight Drive Medicare program activities by managing workplans, tracking milestones and deliverables, identifying and mitigating risks, and ensuring timely execution across the Medicare line of business. Continuous Improvement & Operational Excellence Support ongoing program improvements by identifying operational gaps, facilitating solutions across departments, and promoting best practices that strengthen Medicare program effectiveness and compliance.

Requirements

• Strong verbal and written communication skills with the ability to clearly convey information and ideas to diverse audiences.
• Demonstrated ability to prioritize competing demands, manage resources effectively, and adapt to evolving business needs.
• Proven ability to build and maintain constructive, collaborative working relationships across all levels of the organization.
• Experience representing the organization and providing information to internal and external stakeholders, including customers, regulatory entities, and business partners.
• Demonstrates high ethical standards, integrity, and alignment with organizational values; inspires trust and credibility.
• Supports team development by recognizing contributions, fostering collaboration, and promoting a positive, respectful work environment.
• Experience managing complex, multi-faceted projects, including both short- and long-term initiatives with varying team sizes.
• Strong interpersonal and facilitation skills, including the ability to lead meetings, resolve issues, and influence outcomes through problem-solving and persuasion.
• Ability to motivate and lead participants at all organizational levels without direct authority.
• Working knowledge of project management methodologies, tools, and best practices.
• Self-motivated with the ability to exercise sound independent judgment and decision-making.
• Demonstrated ability to work cooperatively to set goals, resolve problems, and make decisions that enhance organizational effectiveness.
• Excellent organizational and time management skills, with a proven ability to manage multiple projects concurrently.
• Strong analytical and critical thinking skills, with the ability to identify risks, develop solutions, and mitigate potential issues.
• Ability to effectively manage and support organizational change.
• Proficient decision-making, problem-solving, listening, and independent thinking skills.
• Proficiency in Microsoft Office applications and experience using project planning and tracking software.
• Knowledge of and experience with the software development life cycle (SDLC)
• Bachelor’s degree (or equivalent) in business, healthcare, technology, or a related field; an equivalent combination of education and relevant experience may be considered.
• Ten (10) or more years of related experience managing complex projects and/or programs.
• Project Management Professional (PMP®) certification required.

Nice To Haves

• Extensive knowledge of the core operational functions of a managed care organization.
• Program Management Professional (PgMP®) certification preferred.
• Experience in Medicare program management or leading Medicare-related initiatives preferred.

Responsibilities

• Medicare Program Leadership & Strategy Execution - (Driving Medicare program direction, product development, and strategic initiatives) Assist the Medicare Director in annual Medicare bid development in collaboration with Actuarial, Finance, and Product teams. Support the management and implementation of supplemental benefits, ensuring alignment with operational readiness and member communications. Assist the Medicare Director in the development and refinement of D-SNP workflows and operational processes. Support continuous improvement and compliance initiatives related to the Medicare product, including regulatory updates, policy changes, and operational enhancements. Obtain senior management approval for the D-SNP product by presenting the product charter, including high-level costs and benefits.
• Cross-Functional Coordination & Governance Facilitation - (Facilitating governance bodies, workgroups, and cross-departmental alignment) Serve as the operational program manager for Medicare governance bodies, including D-SNP Operations Meetings, Governance Committee, and focused workgroups. Develop agendas, compile background materials, and track follow-up items to support effective governance meetings and decision-making. Monitor progress on governance action items and ensure accountability across departments. Establish alliances with departments and organizations by identifying dependencies and securing partnership commitments. Facilitate cross-functional collaboration to ensure clear communication, aligned responsibilities, and timely issue resolution. Manage relationships with project sponsors and team members through meetings and status updates.
• Program Management & Operational Oversight - (Planning, execution, tracking, and delivery of Medicare initiatives) Manage multiple concurrent Medicare initiatives to ensure successful execution, on-time delivery, and scope alignment. Develop, maintain, and track operational workplans, timelines, action items, risks, and deliverables across Medicare workstreams. Prepare program status updates, dashboards, and presentations for leadership, steering committees, and internal partners. Collaborate with the Enterprise Project Management Office using standardized project management tools and templates; assist and educate department leads on project management practices. In collaboration with Operational Excellence, model and implement project management methodologies across the project lifecycle.
• Continuous Improvement & Operational Excellence - (Strengthening processes, compliance, reporting, and operational effectiveness) Support development and maintenance of Standard Operating Procedures (SOPs) and Policies & Procedures (P&Ps). Maintain governance documentation and records to support audits, regulatory reviews, and internal oversight. Assist with data gathering, analysis, and reporting for CMS, State, and internal requirements. Support development and maintenance of program dashboards and performance reports. Monitor CMS guidance and HPMS memos and track operational impacts. Perform other duties as assigned in support of Medicare product operations and organizational priorities.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager