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Director, Medicare Operations

This job is available in 2 locations

Director, Medicare Operations

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You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose: The Director Medicare Operations is responsible for leading the implementation and ongoing monitoring of activities that support the multi-year Medicare Advantage strategy. This position ensures preliminary and ongoing compliance with all CMS regulations, including but not limited to ensuring required filing and reporting requirements are met. The Director of Medicare Operations is part of the Medicare leadership team.

  • Leads cross-functional Medicare Advantage Operating Team, to include Directors from across the enterprises that are accountable for the success of this line of business. Influences and collaborates with others to execute operational priorities within the Medicare & Consumer Operations strategy.
  • Responsible for overseeing all issue management: triage, prioritization, communication and tracking implementation of resolution cross functionally.
  • Partners with key internal partners – e.g. Star Team - to ensure timely issue resolution, coordinated cross-channel member communications for Medicare members.
  • Monitors and identifies opportunities for process improvements, builds business cases to support improvement opportunities and works cross-functionally to build support for approval of these initiatives.
  • Defines and executes strategies to drive operational efficiency, self service capabilities, in partnership with IT and other accountable leaders within the matrix, to improve P&L performance around managing bad debt, G&A, supporting enrollment and retention goals.
  • Represents Medicare Advantage in monthly Program Management Review process, EPCO steering committees, etc.
  • Directs and implements various Medicare work group deliverables to ensure they support business objectives and meet all compliance requirements.
  • Proactively monitors all contractual and regulatory SLAs and develops internal SLAs where necessary to ensure performance standards are being met. Develops and manages operational dashboards that emphasize the overall health of the Medicare Advantage business.
  • Manages processes to collect, review and submit risk, quality, and service metrics reporting and ensure reports are submitted as required.
  • Develops and maintains collaborative relationships with leaders and third party partners, including CMS and IPAs/Medical Groups.
  • Responds to audit findings and ensures teams are assembled to address deficiencies.
  • Assesses program capacity and capabilities for managing CMS and oversees SME support of initial and annual client implementations, key business functions, processes and the departments supporting Medicare Advantage.
  • Coordinates functions and communications throughout the organization as a “hub” to ensure the successful delivery of the Medicare program.
  • Directs and manages the implementation of new CMS program requirements and transfers operational ownership to the appropriate department once implementation is complete.
  • Ensures Medicare program and products meet all regulatory requirements.
  • Determines, develops and continually improves objectives and policies for the Medicare program and identifies and resolves any issues that may hinder program success.
  • Provides effective leadership to staff (direct and indirect) with particular attention to the effective recruitment, mentoring and ongoing leadership of his/her organization.
  • Responsible for associates’ work climate and provides leadership for initiatives to improve/maintain a positive climate.
Education/Experience: Bachelor’s Degree in Marketing and Sales, Business Administration or related field, or equivalent experience. Master’s Degree in Healthcare Management, MBA, or equivalent degree is desired. Minimum of seven years professional or supervisory experience in an HMO or other managed care organization with Medicare Advantage experience.

Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.

Pay Range: $126,900.00 - $234,600.00 per year

Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

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