Medicare Segment Manager
- Compensation
- Not disclosed
- Location
- Rochester
- Work setup
- Not specified
- Seniority
- Not specified
- Employment
- Not specified
- Experience
- Not specified
- Category
- Not specified
- Posted
Skills
Must have
- · 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.
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- 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
- 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
- Please note: There may be opportunities for remote work on all jobs posted by the LBS Recruitment team. This decision is made on a case-by-case basis.
- 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 protec
Full description
Job Description:
Summary:
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.