Massachusetts Creative Jobs

MassHire Job Quest Logo

Job Information

Intermountain Healthcare Medicare Program/Products Director in Boston, Massachusetts

Job Description:

The Medicare Program/Products Director leads the development, implementation and ongoing operation of Medicare products and services across the SelectHealth multi-state service area with responsibility for the Medicare product lines. This leader directs and coordinates all activities associated with existing products (Medicare Advantage, Duals Special Needs, MA Only Veterans, Prescription Drug Plan, etc.) and new Medicare products to assure that corporate performance objectives are met in a timely, effective and efficient manner. The Director develops new products that meet the needs of customers and drive enrollment growth, increased market share, and profitability.

This position will coordinate, direct and monitor activities across multiple departments to assure that Medicare performance goals, including but not limited to, membership and growth goals, financial goals, medical management goals, customer service goals, regulatory, and compliance requirements, are met. This position will serve as the primary interface with Center for Medicare and Medicaid Services (CMS) and will be responsible for continued development and implementation of Medicare program strategies and work plan, as approved by senior leadership.

May consider candidates outside of the Intermountain/SelectHealth service area (Utah, Idaho, Nevada) with the ability to travel and work on-site as-needed for this role. We are not currently hiring remote workers in the following states: CA, HI, IL, MD, MA, NJ, NY, OR, WA.

Scope

This position will be responsible to establish and lead a comprehensive Medicare program for SelectHealth.

Job Essentials

  • Develop and implement long term strategy and work plan for Medicare Advantage program and other Medicare products and achieve expected operating results.

  • Refine and monitor key performance indicators (KPIs) for the Medicare Advantage program. Intervene as needed and escalate any issues where performance falls outside of expected levels. Provide an executive summary regularly senior leadership on these indicators. (Examples of the KPIs for the Medicare program include, but are not limited to, the following: Membership and enrollment, disenrollment, Medical Loss Ratio, utilization trends including Part D, profitability, effectiveness of revenue optimization and medical expense controls.)

  • Collaborate with Health Services and Pharmacy Services to develop and monitor Medicare specific utilization and PMPM cost measures.

  • Collaborate with other departments, including Planning, Marketing, Quality, Provider Contracting, Member Services, Sales, Broker Relations, Enrollment and Information Systems to develop performance metrics and implement strategies that will enhance Medicare products and services.

  • Monitor the administrative budget for the Medicare program, including FTEs assigned to support Medicare initiatives.

  • Monitor and collaborate with Marketing on the execution of all brand and direct to consumer advertising, public relations, television, digital outreach, and mail campaigns.

  • Collaborates with appropriate teams and individuals as needed to maximize effectiveness of the various functions and assure performance improvement if actual results fall outside of expected parameters.

  • Collaborate with the Corporate Compliance Officer, SelectHealth Compliance Coordinator, and line management to ensure compliance with CMS regulations. Refine and monitor KPIs around key compliance activities. Intervene as needed and escalate any issues where compliance activities fall outside of expected levels. Provide support for preparation and follow up for CMS site visits and audits, as needed.

  • Assure that all educational, product training and agent certification programs are updated annually and implemented for all appropriate internal and external parties. Provide direction on key messaging to assure consistency across the organization.

  • Oversee all activities related to new Medicare product applications, service area expansions and the annual bid process, including completion of SWOT analysis and competitive market assessment Serve as designated administrative lead for interaction with CMS. Work with CMS to foster positive working relationship.

Minimum Qualifications

Bachelors Degree in Health Care Administration, Business or a related field from an accredited institution, which will be verified.

  • and -

7 years experience in a leadership role within a Medicare Managed Care plan

  • and -

Demonstrated effectiveness working with CMS and Medicare Compliance Programs

  • and -

Demonstrated effectiveness in new product development and implementation

  • and -

Demonstrated effectiveness in building collaborative relationships with physicians/providers

  • and -

Demonstrated effectiveness in managing large and complex projects

  • and -

Excellent verbal, written and interpersonal communication skills

  • and -

Excellent public speaking and presentation skills

  • and -

Demonstrated leadership abilities to interact effectively with people across organizational boundaries

  • and -

Demonstrated ability to plan, organize, direct and assure completion of complex work on time and within budget

  • and -

Results orientation, with positive 'can-do' attitude and ability to 'think out of the box'.

  • and -

High integrity and absolute commitment to compliance

Preferred Qualifications

Masters Degree in Health Care Administration, Business or related area

Prior responsibility and demonstrated success in Medicare including developing multiple products to drive enrollment growth and market share

  • and -

Strong understanding of the integrated delivery system model, with demonstrated ability to effectively build relationships with all a wide range of stakeholders

  • and -

Demonstrated ability to manage and develop direct reports

#LI-EXECRC

Physical Requirements:

SH only

Interact with others requiring employee to verbally communicate as well as hear and understand spoken information.

  • and -

Operate computers, telephones, office equipment, and manipulate paper requiring the ability to move fingers and hands.

  • and -

See and read computer monitors and documents.

  • and -

Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment.

Location:

Nevada Central Office, SelectHealth - Idaho, SelectHealth - Murray

Work City:

Murray

Work State:

Utah

Scheduled Weekly Hours:

40

Equal Opportunity Employer

Intermountain Healthcare is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

The primary intent of this job description is to set a fair and equitable rate of pay for this classification. Only those key duties necessary for proper job evaluation and/or labor market analysis have been included. Other duties may be assigned by the supervisor.

All positions subject to close without notice. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, age, national origin, disability or protected veteran status. Women, minorities, individuals with disabilities, and veterans are encouraged to apply.

Thanks for your interest in continuing your career with our team!

DirectEmployers