Medicare Director

JOB SUMMARY:   Provides leadership for Medicare line of business staff and functions including LOB strategy, membership analysis, group and individual sales, market analysis, and overall line of business performance management. Direct and manages the Medicare product life cycle, including new development, product modifications, and coordination of product and benefit administration. Accountable for creating a culture of compliance, ethics and integrity. Maintains knowledge of and assures departmental compliance with Kaiser Permanente?s Principles of Responsibility and policies and procedures, and applicable regulatory requirements and accreditation standards. Responds appropriately to observed fraud or abuse.

POSITION REQUIREMENTS:

 

Master?s degree in business administration, public policy, health care administration or related field or equivalent experience/degree.
Five years of supervisory experience in health care/insurance industry.
Three years experience in product line management, marketing management or complex project management.
Excellent verbal/written communication, public presentation, negotiation, collaboration and department leader skills.
Demonstrated analytical and strategic planning skills.
Experience in working with regulatory agencies and managing a large organization?s response to actions. Ability to interpret and communicate laws and regulations related to health care, HMO?s, disability carriers and HCSCs.
Strong marketing and sales experience working with seniors and external customers including brokers and employers.

ESSENTIAL RESPONSIBILITIES:

 

Develops and implements overall strategic/business plan for Medicare LOB.
Manages the department to optimize outcomes in support of organizational initiatives for Medicare line of business, market planning and strategies, and related data/systems support. Consults with staff in all functional areas to determine capabilities, needs, and gaps that impact capacity for membership growth.
Leads the development of multi-year strategy and business plan for all Medicare segments. Work includes working closely with Senior Leadership and their teams across CPMG, Operations, HPA, Finance, IT, Compliance and others to support organizational goals and effective on-going operations.
Achieves targets outlined in the business plan for Medicare lines including individual and group membership, profitability and revenue.
Coordinate with Medicare Finance to ensure integrity of our bid submission and revenue stream integrity. Coordinate with Actuarial and DSS to ensure timely, accurate data reporting that supports actionable improvement initiatives.
Participates in relevant National and local committees as well as fostering excellent relationships with CMS in providing direction on Medicare issues and input for key policy decisions.
Develops and delivers coordinated response on key Medicare issues to local Senior Leaders, Program Office, CMS and media.
Makes decisions on resolution and escalation of Medicare product, strategy and LOB performance issues, including risk analysis of the situation.
Overall responsibility for the relationship with the CMS regional office, for submissions to the CMS regional office and addressing issues raised by the CMS regional office. Negotiates with CMS in concert with Program Office.
Clearly articulates, advocates and negotiates with key leaders and CMS on issues of significant interest for KPCO.
Strong leader for the department staff and working cross-functionally across the organization and externally with employers/brokers on all issues related to Medicare.
For the next several years, Medicare will be in tremendous flux particularly in the area of payment methodologies and compliance issues. Discern what are right decisions and implementation steps to ensure maximum financial, service and quality performance for Medicare while reducing any non-compliance risks.
Responds to developments and new requirements imposed by CMS; plans effectively in an uncertain and volatile environment; develops strong relationships with state and federal governmental authorities.
Keeps current with changes, proposed or considered, of Medicare laws, regulations, contracts and rulings and act upon them on appropriately on behalf of KPCO balancing competing interests of business, financial, economic and efficiency goals with regulatory, risk management and/or public affairs? concerns.
Coordinates MMA and other regulatory change implementation activities throughout the region.


ENVIRONMENTAL FACTORS: Standard office environment.


SCHEDULE:  Monday-Friday 8:30a.m.-5:00p.m.

 

 

Please e-mail resume to