Job description

Director of Medicare

Only open to candidates residing in California

Opportunity to make a difference in your community

Position not eligible for sponsorship

General Description

Responsible for directing and coordinating all aspects of operation of the Medicare Dual-Eligible Special Needs Plan (D-SNP) for HPSM, also known as CareAdvantage. This includes overseeing the CareAdvantage Customer Navigation call center, Sales and Marketing, and Program Management functions to achieve organizational goals. Reporting to the CMO, this position will conduct long-term planning and oversee operations to improve member experience, achieve health outcomes, and maintain financial stability for
CareAdvantage.

Duties & Responsibilities

Essential Functions:

• Direct and oversee the CareAdvantage Customer Navigation call center, including accountability for CareAdvantage member services and enrollments/disenrollments; ensure strong call center operations and processes to provide a high-quality member experience and meet regulatory requirements.
• Direct and oversee the CareAdvantage Sales and Marketing function. This includes:
• Oversee the work of the Manager, Medicare Sales and Marketing to achieve organizational sales targets.
• Keep abreast of local Medicare marketing conditions and competition as well as national Medicare trends and regulatory changes; collaborate with relevant departments to conduct marketing analysis and planning.
• Collaborate with the Marketing and Communications Department to plan, oversee, and execute on HPSM’s marketing and communications related to our CareAdvantage D-SNP line of business.
• Create and maintain an effective organizational structure, develop staff skills and competencies, and collaboratively define departmental goals and strategies for CareAdvantage.
• Analyze and monitor reports and dashboards to measure D-SNP performance and identify improvement opportunities.
• Lead, coordinate, and drive internal work groups to manage the CMS Star Ratings program; support the execution of the annual CAHPS member survey, as well as drive efforts to enhance CAHPS results; collaborate with internal teams on execution, analysis, and adjustments related to the annual CAHPS member survey.
• Coordinate, participate in, and support the work of all internal departments and external actuaries involved in the annual CMS bid process. This includes collaboration with the external actuary and internal departments such as Marketing, Compliance, Health Services, and Provider Services.
• Collaborate with Compliance and other departments to ensure HPSM is appropriately addressing relevant program requirements, i.e., those distributed through ongoing HPMS memos and the annual CMS Call Letter; coordinate and ensure all necessary CMS and state reporting for the D-SNP program coming from various teams are timely.
• Lead and contribute to relevant HPSM Committees such as the Care Advantage Advisory Committee.
• Support Health Services to achieve compliance with the Model of Care.
• Accomplish staff results by communicating job expectations; planning, monitoring, and appraising job results; coaching, counseling, and implementing corrective action steps when necessary; developing, coordinating, and enforcing systems, policies, procedures, and productivity standards; complete performance evaluations in a timely manner.

Secondary Functions:

• Represent HPSM in a variety of state, national, and local coalitions and forums regarding Medicare

Advantage and D-SNP programs.

• Other duties as assigned.

Requirements

These are the qualifications typically needed to succeed in this position. However, you don’t need to meet every requirement to apply.

Education and experience

Education and Experience equivalent to:

• Bachelor’s degree in health administration; public policy; business; social science and five (5) years’ work experience in a position requiring knowledge of managed care, Medicare and the essential functions of the position.

Knowledge of:

• State and federal managed care program requirements, including Medi-Cal and Medicare health care laws and regulations.
• Comprehensive program planning and development, management, and evaluation approaches.
• Member engagement strategies.
• Principles of cultural humility and cultural sensitivity.
• Supervisory principles and practices as well as techniques and methods to organize and manage direct reports.
• Personal computers and Microsoft Office Suite applications, including Outlook, Word, Excel, Access and PowerPoint.

Skills:

• Excellent research and writing skills.
• Effective public speaking skills.
• Accountability, demonstrated by taking responsibility for achieving results and meeting expectations.
• Interpersonal awareness, demonstrated by effectively listening to members and colleagues, noticing and interpreting others’ concerns and feelings, and communicating with respect. Thorough attention to detail, demonstrated by consistently ensuring that one’s own work and that of contributors meets department standards on quality.

Ability to:

• Work cooperatively and effectively with individuals from all backgrounds and identities. Work as part of a team and support team decisions.
• Utilize both qualitative and quantitative analysis to identify system or process issues and propose solutions.
• Communicate effectively, both verbally and in writing.
• Continually learn new and complex information regarding regulatory and operational topics, specifically pertaining to the D-SNP program.
• Adapt to changes in requirements/priorities for daily and specialized tasks.
• Foster trust and increase engagement with HPSM members.
• Take initiative, plan work, and independently carry out tasks without detailed instructions.
• Demonstrate a friendly and professional demeanor even during stressful situations.

Salary and benefits

The starting salary range is $137,000 - $188,000 per year, depending on the candidate’s work experience.

Excellent benefits package includes:

• HPSM-paid premiums for employee’s medical, dental and vision coverage (employee pays 10% of each dependent’s premiums)
• Fully paid life, AD&D and LTD insurance
• Retirement plan (HPSM contributes equivalent of 10% of annual compensation)
• 12 paid holidays a year, 12 paid sick days a year and paid vacation starting at 16 days a year
• Tuition reimbursement plan
• Employee wellness program

It is HPSM's policy to provide equal employment opportunity for all applicants and employees. HPSM does not unlawfully discriminate on the basis of race, religion, color, national origin, ancestry, physical disability, mental disability, medical condition, marital status, sex, age, sexual orientation, veteran status, registered domestic partner status, genetic information, gender, gender identity, gender expression, or any other characteristic protected by applicable federal, state, or local law. HPSM also prohibits discrimination based on the perception that an applicant or employee has any of those characteristics or is associated with a person who has or is perceived to have any of those characteristics.

Job Type: Full-time

Pay: $137,000.00 - $188,000.00 per year

Benefits:

• Dental insurance
• Employee assistance program
• Employee discount
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Parental leave
• Professional development assistance
• Referral program
• Retirement plan
• Tuition reimbursement
• Vision insurance

Schedule:

• Monday to Friday

Work Location: Remote

shipshapebody.com is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, shipshapebody.com provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, shipshapebody.com is the ideal place to find your next job.