Director Medicare Program Development

2 weeks ago

Springfield, Illinois, United States Health New England Full time
Purpose

Leads Health New England's strategic Medicare development, management, and enhancement program and services and plays a crucial role in setting the vision and growth strategy across all distribution channels (considering both product and strategic footprint implications).

Liaises with internal and external leaders to gain awareness and build out the multi-year expansion, synergies, and growth strategy. Serves as an informational and regulatory SME for all HNE partners. Represents HNE's Medicare Program in the public, attending Regulatory meetings, legislative updates and other public presentations as appropriate and partners with organizational leadership to identify, track, manage, and implement strategies while sustaining a strong relationship with The Executive Office of Health and Human Services (EOHHS) and CMS.

Accountabilities
  • Leads and drives a customer focused culture throughout their team to deepen client relationships and leverage broader business relationships, systems and knowledge
  • Understands how Health New England's business and culture should be considered in day-to-day activities and decisions
  • Creates an environment in which his/her team pursues effective and efficient operations of his/her respective areas in accordance with Health New England's Values, its Code of Conduct and the Associate Handbook, while ensuring the adequacy, adherence to and effectiveness of day-to-day business controls to meet obligations with respect to operational, compliance, and conduct
  • Builds a high performance environment and implements a people strategy that attracts, retains, develops and motivates their team by fostering an inclusive work environment and using a coaching mindset and behaviors; communicating vison/values/business strategy; and, managing succession and development planning for the team
  • Leads Health New England's Medicare strategic opportunities within existing and expansion markets, develops additional growth strategies, and assesses opportunities with customers (prospective and current) and partners.
  • Develops Health New England's Medicare strategic plans to mitigate risks in operational processes that could impact the plan's effectiveness in satisfying regulatory deadlines and other legal requirements as well as identifies emerging product/market trend vulnerabilities and opportunities through analysis; reviews, development and implementation of action plans.
  • Serves as HNE contact with Regulatory agencies and departments to ensure alignment with financial compliance with all State and Federal regulations and requirements.
  • Actively participates in all activities to support the collaborative work with all HNE partner organizations and provides direction to ensure HNE maintains compliance with all State and Federal regulations and requirements.
  • Collaborates with distribution and matrix partners (Compliance & Regulatory, Sales, Marketing, Communications, IT, Network Contracting, Risk Adjustment, Medical/Health Services, and Finance) to manage the objectives of the line of business, improving quality and ensuring top rated experience for members and partners.
  • Partners with the Finance, the Revenue, Enrollment and Risk Adjustment and the Actuary team to understand financial drivers, support reporting and budget oversight functions, and the coordination and development of business unit financial plans and forecasts as well as to assess the revenue stream and work toward streamlining and ensuring the Line of Business maximizes revenue opportunities for sustainability.
  • Develop & monitor comprehensive strategies to support financial position while managing Medicare Profit and Loss statement (P&L) to help identify any potential concerns
  • Provides oversight of all financial activities for the Medicare line of business, regulatory and operational requirements while ensuring alignment with corporate leaders to execute short and long-range strategic plans.
  • Coordinates the development and monitor implementation action plans to seize high-reaching opportunities and respond to performance shortfalls/plan variances.
Job Title: Director Medicare Program Development /Medicare Advantage

Reporting Relationships (Job Titles only)

Manager:

(include secondary Manager if applicable)
  • Chief Growth Officer / VP Growth (TBD)
Direct Reports:
  • Sr Medicare Program Analyst
Shared Reports (solid/dotted if applicable):

External/Internal Contacts

Internal
  • Most all HNE departments
External
  • CMS
  • Commonwealth of MA
  • Milliman
  • Number of external vendors
Dimensions Examples:
  • Number of employees / span of control
  • All of Health New England's Business units
  • Financial dimensions (e.g., capital budget, annual project cost, operating budget, etc.)
  • Number of projects / Number of systems
  • Regulatory bodies and special requirements
  • Signing Authority
Education / Experience / Other Information (include only those that are specific to the role)

Bachelor's degree (Master's Degree preferred) in health administration or science (i.e. Social Work, Public Health) preferred with a minimum of 7 years of experience leading a Medicare Program or an equivalent combination of education and experience. Medicare Sales Certification and Massachusetts Health Producers license an asset. In addition:
  • Expert-level knowledge of Medicare programs, regulations, and operations
  • Strong relationship builder
  • Strong leadership, communication, presentation, and organizational skills
  • Strong networking skills and strategic mindset with a strong focus on profitable growth
  • Knowledge of compliance procedures and regulatory requirements
  • Ability to learn quickly, adapt to change in a fast-paced environment
  • Expert knowledge and ability to work in a team & business partnership environment
  • Expert level of understanding of (industry) landscape, (trends, and key competitor strategic direction)
  • Strong analytical, creative problem solving and negotiation skills

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