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Medicare Operations Manager
2 months ago
Are you ready to utilize your leadership skills and strategic healthcare expertise to establish a new business segment? In this role, you will report directly to the Director of Medicare Product and be accountable for guiding leadership and team members in the creation and launch of the Medicare Dual Special Needs Plan (D-SNP) at the Association for Community Affiliated Plans (ACAP). Additionally, you will oversee ongoing compliance and ensure the operational excellence of the program.
Your leadership capabilities will be essential as you manage the team in operational planning, serve as a Medicare subject matter expert, and collaborate with operational leaders to recommend process enhancements that meet compliance and operational objectives.
Please note that this position is classified as hybrid, requiring an on-site presence a few days each month.
Key Responsibilities
Immediate Tasks
- Utilize your Medicare expertise to support ACAP's D-SNP operational framework and drive planning and implementation initiatives.
- Facilitate informed decision-making in developing the Medicare program by sharing industry best practices and leading tactical workstreams.
- Assist internal stakeholders in identifying, developing, and executing both short- and long-term strategies for launching the D-SNP product.
- Act as an internal subject matter expert (SME) to ensure the operational readiness and performance of D-SNP functions, including Marketing, Sales, Enrollment, Risk Adjustment, and STAR ratings.
- Collaborate with the Enterprise Project Management Office to create project plans, operational readiness plans, and timelines for a successful D-SNP launch.
- Ensure compliance with network adequacy standards by coordinating reporting and documentation with relevant departments.
- Work with Member Services to devise and implement a strategy for D-SNP Customer Services and Grievances and Appeals.
- Develop internal communication materials and training criteria for ACAP employees and associated entities.
- Contribute to the development of the Medicare program through requirements gathering, business case formulation, and improvement strategies.
- Lead detailed data analysis to support program initiatives.
- Provide support to functional teams through information sharing, training, and collaboration.
- Enhance program efficiency and service quality by monitoring performance and identifying improvement opportunities.
- Analyze the dual eligible population and market landscape to identify D-SNP product opportunities.
- Oversee the annual design and application process for the Medicare/D-SNP plan benefit package.
- Manage the product development lifecycle, including application processes, bid development, benefit designs, and market strategies.
- Collaborate with Marketing & Communications to ensure compliance in developing beneficiary communications, including the Medicare Summary of Benefits and Annual Notice of Change.
- Seek opportunities to boost efficiency and ensure regulatory compliance through improved operations.
- Collaborate with internal project teams to deliver products from design to completion, monitoring projects throughout their lifecycle.
Qualifications
- Bachelor's Degree or an equivalent combination of education and experience.
- A Master's degree is preferred.
- A minimum of 10 years of experience in product development, process improvement, or product management, particularly in a Medicare context.
- At least 3 years of leadership experience.
- A minimum of 2 years of experience in developing or implementing operational Medicare components.
- Knowledge of state and federal managed care program regulations, including Medi-Cal and Medicare laws.
- Proven ability to lead teams and communicate effectively with staff and executives.
- Familiarity with healthcare and managed care terminology.
- Strong organizational, time management, and project management skills.
- Advanced analytical and problem-solving abilities with a focus on improvement recommendations.
- Proficiency in MS Office applications and shared document systems.
Benefits
- Comprehensive health benefits with multiple plan options for you and your dependents.
- Retirement plans including employer-matched pension and 401(a) plans.
- Generous time off policy, including Paid Time Off (PTO) and paid holidays.
- An engaging work environment with talented individuals dedicated to transforming healthcare.
Join us in making a positive impact on the lives of many individuals served by ACAP.
