Medicare Segment Manager

Univera Healthcare•Rochester, NY

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 Medicare products and programs are administered according to approved benefit designs, regulatory requirements, and strategic objectives, and is accountable for related service and operational requirements. The position requires knowledge of Medicare Advantage, Medicare Supplement, Part D Prescription Drug Plans, and Dual Eligible products. The manager develops strategic, operational, and tactical plans; evaluates market opportunities and business cases; assesses operational issues that may contribute to noncompliance or customer dissatisfaction; and works with stakeholders to improve processes and business effectiveness. The role plans and implements projects supporting line-of-business objectives, product and benefit administration, regulatory requirements, process improvement, efficiency, and customer experience. It fosters innovation and process improvement, maintains enterprise relationships, and may act as a regulatory liaison to NYS, CMS, or BCBSA. The position collaborates across business and project teams and integrates Medicare strategies with areas including Marketing, Operational Excellence, Population Health Engagement, Finance, Provider Contracting, Compliance, and Enterprise Information Technology. It represents Medicare on committees and projects, maintains business-process deliverables, solicits customer feedback, interprets complex government regulations, identifies and resolves issues, and provides Medicare subject-matter expertise to business teams. The role monitors market and regulatory developments, coordinates planning across departments, and supports the company’s mission, values, privacy policies, and standards of conduct. Regular and reliable attendance is required; other duties may be assigned. The position requires travel across the health plan service regions as needed. The posting states that remote work may be possible on a case-by-case basis.

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 such as NCQA, CMS, federal and state agencies, including 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-motivation and ability to work independently at times without detailed direction.
Strong computer skills, including MS Word, Excel, and PowerPoint.
Demonstrated analytical ability, strategic thinking, creativity, positive attitude, strong work ethic, and highly effective communication skills.
Ability to establish effective relationships with representatives at all levels across divisions, including senior management, to execute cross-divisional initiatives.
Ability to travel across health plan service regions as needed.

Responsibilities

Develop strategic, operational, and tactical business plans to achieve goals for the Medicare lines of business.
Evaluate new market opportunities, including developing necessary business cases.
Assess operations to identify root causes of problems contributing to noncompliance and customer dissatisfaction.
Consult with team members and stakeholders to streamline systems and processes and improve effectiveness and efficiency.
Plan, develop, and implement projects and initiatives supporting line-of-business objectives, products, benefit administration, regulatory requirements, process improvement, efficiency, and customer experience.
Encourage innovation, process improvements, and personal development within 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 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 cross-functional committees and projects.
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 to ongoing changes and challenges in the regulatory environment.
Coordinate with other departments to incorporate 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 company mission and values, comply with the Corporate Code of Conduct, and maintain member privacy in accordance with corporate policies.
Maintain regular and reliable attendance and perform other functions assigned by management.
Travel across health plan service regions as needed.