Description
The Senior Director is accountable for overseeing all aspects of Medicare programs including business, contracting arrangements, product development, health care delivery systems, compliance with Federal policies and requirements, partnership with MAPMG, Health Plan Administration, Marketing, Sales&Business Development, Communications, and Program Office. The Senior Director is also responsible for managing a team of Medicare specialists.
Essential Functions:
• Operational Responsibilities: Manage the relationship and coordinate activities with functional areas as business, regulatory, operations, care delivery sites, and IT for Medicare Cost and Medicare Advantage products; coordinate resource leverage/alignment with other initiatives throughout the organization; manage Medicare Executive Steering Committee to guarantee that operational issues are identified and addressed efficiently; set key performance metrics and ensure that the Medicare line of business is well-served; drive and manage continuous improvement initiatives related to Medicare; monitor and ensure compliance, organize health plan response to internal/external audits, and coordinate corrective action plans. 30%
• Medicare Advantage: Think and acts strategically by influencing operational roll-out of Medicare Advantage Conversion Project to ensure maximum benefit for KPMAS and alignment of National goals; communicate effectively by advocating Medicare Office priorities to KP executives, facilitating crossfunctional meetings and keeping colleagues informed about project goals, priorities, resources and progress to keep them focused on performance needs and requirements; exert influence, identify solutions and lead resolution strategies in order to advance Medicare Advantage conversion critical success factors. 30%
• Financial Oversight: Make key financial and operational decisions regarding Medicare functions, including the Medicare Office department budget, the Medicare Advantage mega-project budget (including business and IT expenditures), and the Medicare line of business P&L; generates regular financial metrics reporting.
• Organizational Collaboration: Build relationships with KP Program Office and ensure that the Program Office is appropriately notified of KPMAS Medicare activities; manage relationships and collaborations with MAPMG; work with Marketing and Sales as well as Communications to ensure that Medicare growth strategy in on track and consistent with KPMAS expectation.
• Management:Manage a team of Medicare professionals and stand accountable for managing and developing performance to meet department and regional strategies.
• Strategy and Innovation: Lead regional strategy initiatives to ensure that health plan is well-positioned to encourage membership growth, financial sustainability, and relevance to consumers. Identify initiatives for KPMAS to demonstrate innovation, which could take the form of creative partnerships, care delivery or delivery system improvements, or participation in innovative projects managed by the federal government, state government or community partners.
Qualifications
Basic Qualifications:
Experience
• Seven (7) years management experience in Medicare, health care or insurance industry.
• Five (5) years in product line management/health care delivery to special populations.
Education
• Bachelor’s degree in Public Health, Healthcare Administration, or related healthcare field.
License, Certification, Registration
• N/A.
Additional Requirements:
• Strong background working with Medicaid and/or Special populations and unique health care needs.
• Excellent negotiation skills, verbal/written communication skills.
• Strong analytical and strategic planning skills. Excellent public presentation skills.
• Strong persuasive and interpersonal skills.
• Knowledgeable of Medicaid health care delivery systems.
• Knowledgeable of current trends in care management and industry standards related to care delivery to Medicaid population.
• Experience with budgeting; state and federal compliance; state and federal policies and laws.
• Demonstrated ability to build effective partnerships and influence others who may have different perspectives.
• Must be a decisive, results-oriented manager of people. Must excel in developing a highly focused, cohesive team of professionals who are comfortable working in a team environment.
• Demonstrated ability to work in a highly matrixed environment. Strong collaborative and team skills.
Preferred Qualifications:
• Experience with budgeting; state and federal compliance; state and federal policies and laws.
• MBA, MSN, or Masters in Public Health, Healthcare Administration strongly preferred.
• Extensive knowledge of Medicaid health care delivery systems.
• Extensive knowledge of current trends in care management and industry standards related to care delivery to Medicare population.
https://healthy.kaiserpermanente.org/html/kaiser/index.shtml
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