Manager, Medicare Programs
3 months ago
Are you looking to leverage your leadership and strategic healthcare knowledge to build a new line of business? Reporting to the Director, Medicare Product, you will have responsibility for supporting leadership and staff in the development and launch of San Francisco Health Plan’s Medicare Dual Special Needs Plan (D-SNP) as well as the ongoing compliance and high-quality operational performance of staff and the program. Leveraging your leadership acumen, you will lead and manage the team in operational planning, serve as a Medicare subject matter expert, and, in collaboration with operational leaders, provide recommendations on process improvements and lead the program(s) to meet critical compliance and operational needs. Please note – while this position is classified as a hybrid role, it will require an on-site, in-office presence 4 days per month. WHAT YOU WILL DO Immediate Bring Medicare knowledge and experience, support SFHP’s D-SNP operating model, and drive planning and implementation efforts. Support functional decision making in building a Medicare program by sharing expertise of industry best practices and facilitating tactical workstreams. Support internal stakeholders in the identification, development, planning, and implementation of short- and long-term strategies to support the launch of our D-SNP product. Serve as an internal subject matter expert (SME) and ensure readiness of D-SNP operational functions and performance (e.g., Marketing, Sales, Enrollment, Risk Adjustment, STARs). In collaboration with our Enterprise Project Management Office, support the development of project plans, operational and performance readiness plans, and timelines to support a successful D-SNP product launch. Coordinate network adequacy reporting and documentation with Provider Services and other departments to ensure that the plan meets all network adequacy standards for the application and on an ongoing basis. Collaborate with Member Services to develop and implement an operational strategy for D-SNP Customer Services and Grievances and Appeals functions. Develop internal communication documents and Medicare training criteria for SFHP employees and first tier downstream entities. Support Medicare program development with requirements gathering, business case creation, and improvement plans. Contribute to and/or lead detailed data analysis. Support functional teams through information exchange, training, and collaboration. Longer Term Promote increased program efficiency, service levels, and value by capturing and monitoring performance, and then identifying opportunities for improvement and strategies to realize those opportunities. Identify D-SNP product opportunities based on analysis of SFHP’s dual eligible population and the market landscape. Manage the annual Medicare/D-SNP plan benefit package design and application(s) process. Manage and apply product development lifecycle to the application process, bid development, benefit designs, member materials, and go-to-market strategy. In collaboration with our Marketing & Communications function, provide centralized year-round support in Medicare for the development and editing of core beneficiary communications, to include the Medicare Summary of Benefits and Annual Notice of Change/Evidence of Coverage for print and online distribution, ensuring compliance with CMS guidelines. Identify opportunities to increase efficiency, improve service levels, and ensure regulatory compliance through enhanced operations. Actively collaborate with people who are responsible for internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion. Monitor projects from inception through delivery. WHAT YOU WILL BRING Bachelor’s Degree or equivalent combination of education/experience. * Masters degree preferred. 10 or more years experience in product development, process improvement, and/or product management, ideally within a Medicare environment. 3 or more years of leadership (people management) experience. 2 or more years experience developing or implementing operational Medicare components. Knowledge of state and federal managed care program requirements, including Medi-Cal and Medicare health care laws. Ability to successfully lead a team and communicate effectively with staff, management, and executives. Familiar with health care, managed care terminology, or Medi-Cal. Strong organization, time management, and project management skills and multi-tasking abilities. Advanced analytical skills and problem-solving skills with the ability to formulate and communicate recommendations for improvement. Demonstrated proficiency with MS Office (Word, Excel, Outlook, Powerpoint) and shared document repositories (i.e., Sharepoint). WHAT WE OFFER A competitive and robust compensation package, including: Health benefits – several plan choices to cover you and your dependents medical, dental, vision needs. Retirement – Employer-matched CalPERS Pension and 401(a) plans, 457 Plan. Time off – 23 days of Paid Time Off (PTO) and 13 paid holidays. An opportunity to work in a vibrant atmosphere with the most amazingly talented people who are shaping the future of healthcare The chance to make a difference in the lives of many San Francisco residents. ABOUT US Established in 1997, San Francisco Health Plan (SFHP) is an award-winning managed care health plan whose mission is to provide affordable health care coverage to the underserved low and moderate-income residents in San Francisco county. SFHP is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees and its 175,000+ members have access to a full spectrum of medical services including preventive care, specialty care, hospitalization, prescription drugs, and family planning services. SFHP was designed by and for the residents it serves and takes great pride in its ability to accommodate a diverse population that includes young adults, seniors, and people with disabilities. San Francisco Health Plan is proud to be an equal opportunity employer. We are committed to a work environment that supports and respects all individuals and in which our processes are applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, or other protected characteristics. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. San Francisco Health Plan is an E-Verify participating employer. #J-18808-Ljbffr
-
Corporate Counsel, Medicare Transactions, Legal
4 weeks ago
San Francisco, United States Amazon Full timeYou will have experience working with government programs and payors, including drafting and reviewing agreements, advising on fraud waste and abuse laws such as the Anti-kickback Statute, Civil Monetary Penalties Law, False Claims Act, and Stark law. You will effectively manage complex provider transactions, including shared savings/gainsharing contracts,...
-
Programs Manager
3 weeks ago
San Rafael, United States The HR Manager Full timeThe Bailey S Cavachon Foundation, based in San Rafael, California, is seeking an Executive Assistant for the Environment Program. About the Foundation The Bailey S Cavachon Foundation has been making grants since 1969 to help solve social and environmental problems at home and around the world. The Foundation concentrates its resources on activities in...
-
Medicare Account Manager III
4 weeks ago
San Diego, United States Kaiser Permanente Full timeJob Summary: In addition to the responsibilities listed above, this position is also responsible for developing and implementing standard and non-standard competitive sales and retention strategies for Medicare accounts; providing a positive experience to customers with Medicare accounts with minimal guidance; ensuring collaboration within teams to support...
-
Associate Program Manager
1 week ago
San Francisco, United States San Francisco Health Plan Full timeReporting to the Manager of Quality Improvement, the Associate Program Manager, Quality Improvement, is responsible for quality improvement analysis and regulatory oversight. Your core projects include data analysis of clinical and care experience data to support quality improvement, managing a quality improvement program that meets regulatory standards,...
-
Associate Program Manager
2 weeks ago
San Francisco, United States San Francisco Health Plan Full timeReporting to the Manager of Quality Improvement, the Associate Program Manager, Quality Improvement, is responsible for quality improvement analysis and regulatory oversight. Your core projects include data analysis of clinical and care experience data to support quality improvement, managing a quality improvement program that meets regulatory standards,...
-
Associate Program Manager, Quality Improvement
4 weeks ago
San Francisco, United States San Francisco Health Plan Full timeReporting to the Manager of Quality Improvement, the Associate Program Manager, Quality Improvement, is responsible for quality improvement analysis and regulatory oversight. Your core projects include data analysis of clinical and care experience data to support quality improvement, managing a quality improvement program that meets regulatory standards,...
-
Program Manager
2 weeks ago
san francisco, United States Instituto Familiar de la Raza Full timeAGENCY DESCRIPTIONInstituto Familiar de la Raza, Inc. is a multi-service community health and social service agency with emphasis in serving the Chicano/Latino/Indígena community in San Francisco with a special focus on the diverse needs of the Mission District. Services include a wide range of mental health, HIV related services, and social services...
-
Program Manager
2 weeks ago
san francisco, United States Instituto Familiar de la Raza Full timeAGENCY DESCRIPTIONInstituto Familiar de la Raza, Inc. is a multi-service community health and social service agency with emphasis in serving the Chicano/Latino/Indígena community in San Francisco with a special focus on the diverse needs of the Mission District. Services include a wide range of mental health, HIV related services, and social services...
-
Program Manager
2 weeks ago
San Francisco, United States Instituto Familiar de la Raza Full timeAGENCY DESCRIPTIONInstituto Familiar de la Raza, Inc. is a multi-service community health and social service agency with emphasis in serving the Chicano/Latino/Indígena community in San Francisco with a special focus on the diverse needs of the Mission District. Services include a wide range of mental health, HIV related services, and social services...
-
Program Manager
4 weeks ago
San Francisco, United States Ohalo Full timePosition: Program Manager Location: San Francisco, CA, Aptos, CA or Mills River, NC Type: Full-time Desired start date: ASAP The Opportunity: Ohalo is seeking a leader in our organization, to bridge the gap between science and product development, ensuring technical programs align seamlessly with commercial objectives. As program manager you will partner...
-
Program Manager
4 weeks ago
San Francisco, United States eTeam Inc. Full timeRole: Program Manager Location: 100% remote Duration: 6 Months Job Summary: The Data Governance program is responsible for cataloging data, assets, and content across the company and creating actionable frameworks for policy compliance and reporting. As a program manager reporting into this team, you will plan and execute strategic programs, continuously...
-
Program Manager
7 days ago
San Francisco, United States Photon Full timeGreetings From Photon,We hope you are staying safe. We are hiring a Program Manager to join our Digital Engineering team. Who are we?For the past 20 years, we have powered many Digital Experiences for the Fortune 500. Since 1999, we have grown from a few people to more than 4000 team members across the globe that are engaged in various Digital Modernization....
-
Program Manager
4 weeks ago
San Francisco, United States DPP Tech Full timeWe are looking for an experienced technology Program Manager with expertise in strategic technology plan development, corporate stakeholder engagement and technology program management to lead the successful rollout of the technology plan.Qualifications: Candidate must have seven (7) years of proven technology program management experience in successfully...
-
Program Manager
4 weeks ago
san francisco, United States DPP Tech Full timeWe are looking for an experienced technology Program Manager with expertise in strategic technology plan development, corporate stakeholder engagement and technology program management to lead the successful rollout of the technology plan.Qualifications: Candidate must have seven (7) years of proven technology program management experience in successfully...
-
Pharmacy Programs Manager
1 week ago
San Antonio, United States University Health Full timePOSITION SUMMARY/RESPONSIBILITIES Oversight and leadership of clinical management and process improvement programs to promote safe and cost effective use of medications. Service provided for neonatal through adult patients in the hospital subject to Joint Commission, OSHA, Medicare/Medicaid standards and Texas State Board of Pharmacy Rules and Regulations....
-
Program Manager
4 weeks ago
San Francisco, United States Saxon Global Full timeThis Program Manager will be challenged to perform in a fast paced environment with many moving parts responsible for managing multiple enterprise application/software and complex integrations projects that have a direct impact on company revenue and growth. This role requires strong communication skills, diplomacy and an even temperament to manage technical...
-
Program Manager
2 weeks ago
san francisco, United States Tundra Technical Solutions Full timeMeta is looking for a Talent Program Specialist! Location: Hybrid in either San Francisco, CA, Menlo Park, CA, Washington, or Oregon.DescriptionMeta’s mission is to give people the power to build community and bring the world closer together. Through our family of apps and services, we're building a different kind of company that connects billions of...
-
Program Manager
2 weeks ago
San Francisco, United States Tundra Technical Solutions Full timeMeta is looking for a Talent Program Specialist! Location: Hybrid in either San Francisco, CA, Menlo Park, CA, Washington, or Oregon.DescriptionMeta’s mission is to give people the power to build community and bring the world closer together. Through our family of apps and services, we're building a different kind of company that connects billions of...
-
Program Manager
1 week ago
san francisco, United States Tundra Technical Solutions Full timeMeta is looking for a Talent Program Specialist! Location: Hybrid in either San Francisco, CA, Menlo Park, CA, Washington, or Oregon.DescriptionMeta’s mission is to give people the power to build community and bring the world closer together. Through our family of apps and services, we're building a different kind of company that connects billions of...
-
Program Manager
4 weeks ago
San Francisco, United States The Salvation Army USA Western Territory Full timeDescription OVERVIEW: The Salvation Army is seeking a Program Manager for the Joseph McFee Center, who will be part of the leadership team responsible for overseeing the day-to-day operations of the 100-bed facility located in San Francisco's Mission District. This includes managing staff, designing and implementing comprehensive support services for...
