Director of Medicare

Director of Medicare

Looking for a way to make an impact and help people?

Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.

The Director of Medicare is responsible for building, overseeing, and driving the success of our Medicare line of business, including retail Medicare Advantage and Dual Special Needs Plan (DSNP) segments. This role is responsible for supporting and executing a profitable growth strategy. The Director will be the subject matter expert, champion, and leader for Medicare with corresponding supporting accountability for profit and loss (P&L), strategic planning, and execution against strategies. This position develops strategic plans and annual work plans consistent with PacificSource's enterprise strategy and is responsible for executing on the strategic plan directly and through others. This work includes leading internal teams and external partners in aligning strategic planning efforts, resource allocation, and management objectives to ensure success.

Essential Responsibilities :

• Support the Vice President, Medicare and Individual, in managing the P&L for the line of business.
• Develop and execute a strategic plan and annual work plan for the Medicare line of business.
• Ensure the line of business meets all Centers for Medicare and Medicaid Services (CMS) regulatory and contractual requirements.
• Maintain an enterprise view of PacificSource while establishing Medicare priorities, consistent with a deep understanding of the attributes required for success in government-regulated and publicly subsidized health care programs.
• Build and maintain relationships with PacificSource's Medicare provider partners, brokers, regulators, and other internal and external stakeholders, including the Medicaid, Individual, and Employer Group lines of business. Align strategies and tactics to achieve a competitive position, profitable line of business across markets, superior market share, and sustained competitive advantage.
• Ensure that critical initiatives and projects are adequately planned and executed.
• Develop strategic business partnerships with internal departments and leaders to ensure strong operating performance, high levels of member satisfaction and quality performance, access, compliance and audit readiness, and sound financial performance. Monitor departmental and line of business budget.
• Maintain optimal alignment and visibility for Medicare initiatives at all levels of the company through presentations, maintenance of monitoring dashboards, and integration with departmental and individual performance objectives, and deploy efforts to consistently, transparently, and effectively relay strategic messages to the management team and staff.
• Conduct market research, competitive analysis, and financial assessments to evaluate improvement opportunities and business strategies in concert with PacificSource's vision, values, and enterprise strategy.
• Support the organization's commitment to diversity, equity, inclusion, and belonging by fostering a culture of dignity, cultural awareness, compassion, and respect.
• Work closely with the Compliance Department and others to ensure policies, procedures, workflows, lifecycle strategies, product offerings, and success initiatives comply with state and federal regulations.
• Closely monitor policy, legislative, and competitive developments, along with Medicaid and Individual priorities that impact the line of business. Translate these impacts to the organization and lead efforts required for the organization to respond.
• Represent PacificSource externally in community, state, regional, and industry forums.
• Actively participate as a key team member in company leadership and manager meetings.
• Responsible for hiring, staff development, coaching, performance reviews, corrective actions, and termination of employees. Provide feedback, including regular one-on-ones and performance evaluations, for direct reports.

Supporting Responsibilities :

Success Profile :

Work Experience : Minimum of seven (7) years of experience in health insurance operations, product, portfolio, managed care, or equivalent work experience in highly regulated Commercial or Government segments. Minimum of three (3) years of experience in a leadership capacity. Experience in a managed care organization requiring advanced knowledge of Medicare Advantage regulations required. Proven record of success in positions of progressively greater responsibility achieving business goals and objectives, as well as demonstrated success working in a matrixed environment. Experience with the dual-eligible population strongly preferred.

Education, Certificates, Licenses : Bachelor's degree required with a focus in health care administration, business, public policy, public health, or a related field required.

Knowledge :

Knowledge of Medicare, the Medicare Advantage program, and CMS required, along with deep understanding of the key attributes, competencies, and strategies for success. Strong understanding of managed care and publicly financed or subsidized health care. Demonstrated experience and success in working collaboratively in defining and achieving common goals. Ability to communicate, persuade, convince, influence, and negotiate with all levels within and outside of PacificSource, including staff, management, and community stakeholders. Knowledge of business principles and administration, organization, and management activities.

Competencies :

Environment :

Work remotely and inside in a general office setting with ergonomically configured equipment. Travel is required approximately 20% of the time.

Skills : Our Values :

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business :

Physical Requirements :

Stoop and bend. Sit and / or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer : This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.