Executive Director Medicare Programs ED Program Implementation

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Executive Director, Medicare Programs (ED, Program Implementation)

Job Description
Department(s): Senior Programs
Reports To: Chief Operating Officer
FLSA status: Exempt
EEOC Classification: Officials & Managers: Executive/Senior Level
Salary Grade: U - $226,000 - $371,800
Job Summary
The Executive Director of Medicare Programs is responsible for implementation of products for older adults and individuals eligible for coverage under Medicare. Products under the responsibility of this position include Medicare Advantage and Program of All Inclusive Care for the Elderly. This position manages the governance of key decisions to ensure that membership and financial goals and objectives are accomplished within the constraints of budget, schedule, and customer expectations. The incumbent is responsible for overall project coordination, including planning and sequencing work, setting milestones and deadlines, assigning responsibilities, facilitating cross-functional workgroups, monitoring progress, and reporting project status. Acting as a subject matter expert for related initiatives, the Executive Director works closely with elected officials, regulatory agencies, contractors, associations, and key stakeholders.
Position Responsibilities:

• Serves as Executive Lead for Medicare Advantage and the operational leader for the Program of All Inclusive Care for the Elderly (PACE).
• Develops a clear understanding of the business case, strategy, objectives, policy requirements and implications, and overall requirements for these products.
• Lead the development and execution of growth and expansion of Medicare Advantage and PACE, and development of other initiatives or programs to serve the senior population.
• Through the management of governance of key decisions, makes recommendations and articulates reasons for them to CalOptima's Office of the CEO and Board of Directors.
• With support of Government Affairs, develop advocacy positions to support CalOptima's strategic and business needs.
• Responsible for consistent operational compliance and timely reporting to satisfy and exceed state and federal standards; as well as being responsible for the identification, development, and implementation of best practices.
• Directs staff on operational matters and proposes solutions to operational issues and improvements related to services provided to members by other CalOptima departments, vendors/contractors, and Health Networks.
• Develops projects around person-centered care and applicable health related topics that will assist the agency in maximizing health outcomes and improving costs.
• Works with other departments in the development of CalOptima sponsored trainings/seminars/conferences on senior program topics.
• Works in tandem with the clinical leadership in researching -specific policy issues, analyze options, and develop recommendations.
• Represents CalOptima on various community planning bodies and workgroups at the local, state, and national level.
• Ensures that policies and procedures necessary to operate the department comply with regulatory and accreditation requirements and are in place and updated no less than annually.
• Establishes and facilitates thought-provoking meetings of cross-functional workgroups.
• Promotes an environment of innovation and collaboration.
• Accomplishes work through others using communication, negotiation, and priority setting to advance various tasks that are necessary for a successful implementation and that are interdependent, cross-disciplined, and process and technology driven.
• Works closely with CalOptima's leadership team to leverage opportunities for program enhancement and growth in the context of CalOptima's strategic plan.
• Facilitates the transfer of electronic health information and data sharing amongst associated programs.
• Other projects and duties as assigned.

Possesses the Ability To:

• Lead, enhance, and develop effective programs.
• Develop and champion innovative solutions to optimize programs for vulnerable populations.
• Serve as an advocate for integrated programs on CalOptima's leadership team.
• Create and seize opportunities for innovative new program developement.
• Work collaboratively to market and promote program offerings and to develop effective referral protocols.
• Manage, mentor, and lead staff to develop effective working relationships both internally and with community-based organizations, other governmental agencies, and with the population being served.
• Be a thought leader and adviser to senior leaders; experience influencing executives through experience with data and market practices.
• Strategic thinker and problem solver with hands-on, 'roll up your sleeves' can-do attitude.
• Subject matter expert on senior populations targeted by Medicare Advantage and PACE.
• Knowledge of the complex framework of Medicare Advantage and PACE including financing, quality, member engagement, and product requirements, especially as they impact dual eligible populations.
• Strong written and verbal communication skills; Strong analytical, problem solving, influencing, and interpersonal skills; Excellent listening, group presentation, and facilitation skills.
• Build, maintain, and enhance relationships with the County of Orange, Providers, Health Networks, community-based organizations, and other key stakeholders.
• Strong operational focus with proven success at managing and mentoring leaders and staff within an organization.
• Demonstrate strong leadership skills, communication skills, strategic thinking, and proven ability to build strong interpersonal relationships.
• Develop sound and responsible business plans and financial models.
• Work in a highly matrixed, mission-driven public agency.
• Communicate clearly and concisely, both verbally and in writing.
• Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

Experience & Education:

• Bachelor's degree in Business Administration, Health Care Administration, or related field required.
• 7 years of related experience, including supervisory experience.
• Advance knowledge of the healthcare industry specific to Medi-Cal, Medicare or other government programs, to include payor operations, marketing, underwriting, finance, consumer experience, contracting, and network experience.
• Extensive experience working at an executive level in a health care environment, with a successful track record managing Medicare Advantage products required.
• Experience in new program development for vulnerable populations, including strategic planning for a start-up program and implementation of the program required.
• Experience successfully writing and managing grants is required.

Preferred Qualifications:

• Master's degree in Health Administration, Public Health, or other related degree preferred.
• Experience in a government or public environment preferred.

Knowledge of:

• Managed care, Medicare, and Medi-Cal guidelines, with some experience in applying these guidelines to skilled nursing facilities and home and community-based options.
• Government and public sponsored programs.

CalOptima is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima wants to have qualified employees in every job position. CalOptima prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.

If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. You can request reasonable accommodations by contacting Human Resources Disability Management at 657-900-1134.


Job Location: Orange, California
Position Type:

To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/3708






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CalOptima