Medicare Segment Manager

Job Description
Under the general direction of the Assigned Management, this position is responsible for supporting Medicare line of business strategy and execution. assuring that all Medicare products and programs are administered according to approved benefit design, regulatory requirements, and strategic objectives for the line of business. The incumbent is accountable for service and operational requirements associated with the line of business. The incumbent will be knowledgeable in all Medicare products, including Medicare Advantage, Medicare Supplement, Part D Prescription Drug Plans, and Dual Eligible products.

Essential Responsibilities/ Accountabilities

Develops strategic, operational, and tactical business plans to achieve desired business goals for the Medicare lines of business.

Understands and evaluates new market opportunities, including building of necessary business cases.

Conducts evaluation, review, and assessment of various operations for the purpose of identifying root causes of operations problems that contribute to noncompliance and customer dissatisfaction.

Consults with team members and stakeholders to streamline system operations and processes to improve business effectiveness and efficiency.

Plans, develops, and implements special projects, initiatives, and activities to support line of business objectives, product, benefit administration, regulatory requirements, process improvement, efficiency, and the customer experience.

Encourages innovation, process improvements and personal development within the functional business areas that support the Medicare products.

Develops and maintains relationships across the enterprise to promote consistent strategic priorities.

May serve as a regulatory liaison to NYS, CMS or BCBSA as needed.

Collaborates with cross functional business and project teams to ensure alignment to line of business objectives, compliance, operational performance and process improvement.

Ensures cross functional integration of strategies with key internal areas including, but not limited to Marketing, Operational Excellence, Population Health Engagement, Finance, Provider Contracting, Compliance and Enterprise information Technology. Represents Medicare on related key cross-functional committees and projects to ensure Medicare perspective is being integrated into strategies of other areas.

Manages maintenance of business process work item deliverables. Regularly participates in forums and activities to solicit direct customer feedback.

Reads, interprets, and identifies necessary next steps related to complex government regulations.

Engages in issue identification as well as problem solving to identify and resolve potential improvement opportunities.

Serves as a corporate resource for Medicare, providing line of business subject matter expertise to business teams on initiatives and activities that impact the line of business.

Acts quickly to continuous changes and challenges in the regulatory environment.

Works closely with other Departments for input and integration. Ensures all perspectives are considered and develops processes and timelines to incorporate planning and execution of strategies across departments.

Remains current on evolving market dynamics within the Medicare segment, connects trends to line of business objectives and ensures awareness among key business partners.

Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.

Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.

Regular and reliable attendance is expected and required.

Performs other functions as assigned by management.

Minimum Qualifications

Bachelor's degree in health administration, marketing, business administration or related field with a minimum of six years progressive health plan operations experience.

Strong leadership and/or management experience.

Strong expertise and background dealing with regulatory and accreditation agencies such as NCQA, CMS, Federal & State agencies including DOH, Dept. of Finance Services.

Remain current on all relevant regulatory requirements.

Strong process and program management skills, analytical, creativity and initiative in problem solving and solution identification.

Strong facilitation skills and follow through. Project management experience required.

Must be a critical thinker and possess effective negotiation skills in dealing with middle and senior management levels.

Must be self-motivated and a self-starter, able to work independently at times without detailed direction.

Must possess strong computer skills, including MS Word, Excel and PowerPoint.

Must possess strong, demonstrated analytical ability, strategic thinking, and creativity as well as a positive attitude, strong work ethic and highly effective communication skills.

Must be capable of establishing effective relationships with all levels of representation throughout the divisions including senior management to execute cross-divisional initiatives.

Physical Requirements

Ability to travel across the health plan service regions as needed.

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Compensation Range(s)
Minimum: $79,068 - Maximum: $142,322

The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.

Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis.

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