Medicare Segment Manager
About The Position
Under the general direction of assigned management, the Medicare Segment Manager supports Medicare line-of-business strategy and execution. The role ensures that Medicare products and programs are administered according to approved benefit design, regulatory requirements, and strategic objectives, and is accountable for related service and operational requirements. The incumbent is expected to understand Medicare Advantage, Medicare Supplement, Part D Prescription Drug Plans, and Dual Eligible products. The position develops business plans and initiatives, evaluates market opportunities and operational performance, and works with stakeholders across the organization to improve effectiveness, efficiency, compliance, and customer experience. It may serve as a regulatory liaison to NYS, CMS, or BCBSA as needed, and provides Medicare subject-matter expertise to business teams. Travel across the health plan service regions may be required.
Requirements
- Bachelor’s degree in health administration, marketing, business administration, or a related field.
- At least six years of progressive health plan operations experience.
- Strong leadership and/or management experience.
- Strong expertise and background working with regulatory and accreditation agencies, including NCQA, CMS, federal and state agencies, DOH, and the Department of Financial Services.
- Remain current on relevant regulatory requirements.
- Strong process and program management skills, analytical ability, creativity, and initiative in problem-solving and solution identification.
- Strong facilitation skills and follow-through.
- Project management experience.
- Critical-thinking ability and effective negotiation skills when dealing with middle and senior management.
- Self-motivated and able to work independently at times without detailed direction.
- Strong computer skills, including MS Word, Excel, and PowerPoint.
- Demonstrated analytical ability, strategic thinking, creativity, a positive attitude, strong work ethic, and highly effective communication skills.
- Ability to establish effective relationships with representatives at all levels, including senior management, to execute cross-divisional initiatives.
- Ability to travel across the health plan service regions as needed.
Responsibilities
- Develop strategic, operational, and tactical business plans to achieve business goals for the Medicare lines of business.
- Understand and evaluate new market opportunities, including developing necessary business cases.
- Evaluate operations and identify root causes of problems contributing to noncompliance and customer dissatisfaction.
- Consult with team members and stakeholders to streamline systems and processes and improve business effectiveness and efficiency.
- Plan, develop, and implement projects and initiatives supporting line-of-business objectives, product and benefit administration, regulatory requirements, process improvement, efficiency, and customer experience.
- Encourage innovation, process improvements, and personal development in functional business areas supporting Medicare products.
- Develop and maintain enterprise relationships to promote consistent strategic priorities.
- Serve as a regulatory liaison to NYS, CMS, or BCBSA as needed.
- Collaborate with cross-functional teams to align with line-of-business objectives, compliance, operational performance, and process improvement.
- Integrate Medicare strategies with internal areas including Marketing, Operational Excellence, Population Health Engagement, Finance, Provider Contracting, Compliance, and Enterprise Information Technology.
- Represent Medicare on relevant cross-functional committees and projects to ensure the Medicare perspective is incorporated.
- Manage maintenance of business-process work-item deliverables and participate in forums and activities to solicit direct customer feedback.
- Read and interpret complex government regulations and identify necessary next steps.
- Identify issues and solve problems to address potential improvement opportunities.
- Provide Medicare subject-matter expertise to business teams on initiatives and activities affecting the line of business.
- Respond promptly to ongoing changes and challenges in the regulatory environment.
- Coordinate with other departments to gather input, integrate perspectives, and develop processes and timelines for planning and executing strategies.
- Monitor Medicare market dynamics, connect trends to line-of-business objectives, and keep key business partners informed.
- Support the Lifetime Healthcare Companies’ mission and values, comply with the Corporate Code of Conduct, and lead according to Lifetime Way values and beliefs.
- Protect member privacy in accordance with corporate privacy policies and procedures.
- Maintain regular and reliable attendance.
- Perform other functions as assigned by management.
Benefits
- Group health insurance may be available.
- Dental insurance may be available.
- Retirement plan may be available.
- Wellness program may be available.
- Paid time away from work may be available.
- Paid holidays may be available.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
