Under general supervision responsible for providing strategic direction of the Medicare D-SNP Program (the Program) and services. Also responsible for leading the development, implementation and ongoing operation across HPSJ’s service areas in a manner consistent with regulatory requirements and Program and HPSJ strategies and goals, including but not limited to goals for membership, growth, financial, care management, compliance and service. Work is varied and complex, and requires a high degree of discretion and independent judgment.
WHAT YOU WILL BE DOING:
ESSENTIAL FUNCTIONS
- Identifies, develops, plans and executes short- and long-term strategies, participating with peers and others to ensure effective integration; oversees the development and implementation of organization goals and actions plans.
- Directs and/or coordinates staff in the implementation of strategic work plans, development and implementation of new benefits, or other initiatives including but not limited to, CMS Five Star Program operational initiatives and Hierarchical Condition Category (HCC) maintenance and improvement activities.
- Refines and monitors key performance indicators (KPIs) ; intervenes as needed and escalates any issues where performance falls outside of expected levels.
- Collaborates with other departments, including Clinical Operations, Pharmacy, BI, Finance, Marketing, Quality, Provider Network Operations, Customer Services, Sales, Broker Relations, Enrollment and Information Technology to develop performance metrics and implement strategies that will enhance the Program and services and maximize effectiveness of the various functions and assure performance improvement if actual results fall outside of expected parameters.
- Leads the annual bid cycle by working with Actuary, Pharmacy, delegated vendors, and other operational stakeholders; oversees all activities related to the Program application, service area expansions and the annual bid process, including completion of SWOT analysis and competitive market assessment.
- Serves as one of the primary interfaces with Center for Medicare and Medicaid Services (CMS), and designated administrative lead for interaction with CMS; works with CMS to foster positive working relationship.
- Drives secondary research and qualitative and quantitative analysis to inform design and development.
- Develops and manages Program budget; implements appropriate interventions.
- Collaborates with the Chief Compliance Officer, Compliance Director, and line management to ensure compliance with CMS regulations. Provide support for preparation and follow up for CMS site visits and audits, as needed.
- Oversees the development of relevant, timely and accurate internal and external filings, reports and documents.
- Ensures that all educational, product training and agent certification programs are updated annually and implemented for all appropriate internal and external parties; provides direction on key messaging to assure consistency across the organization.
- Monitors and collaborates with Marketing on the execution of all brand and direct to consumer advertising, public relations, television, digital outreach, and mail campaigns.
- Coordinates data mining and data analysis activities for provider contracting and performance oversight and HCC improvement initiatives.
- Collaborates with staff across the organization to research specific issues as necessary to develop and analyze solutions and make policy or programmatic recommendations to address operational issues.
- Provides business requirements and oversees system configurations to ensure the system effectiveness in customer service, provider payments, clinical operations, analytics/reports and other activities that rely on information system solutions.
- Develops and updates Program policies and procedures for review and approval.
- Promotes and maintains and ensures that direct reports promote and maintain an environment that supports HPSJ’s strategy, vision, mission and values.
- Hires, develops and retains a competent staff and ensures that subordinate managers do the same.
Required Skills
WHAT YOU BRING:
KNOWLEDGE, SKILLS, ABILITIES AND COMPETENCIES
- Knowledge of product development techniques and best practices and ability to effectively implement.
- Ability to identify pertinent policy issues and develop strategies, solutions and procedures.
- knowledge of Medi-Cal managed care operations including but not limited to health care financing, managed care payment methodologies, and risk adjustment including Medicare, DHCS, DMHC and Knox Keene rules and regulations.
- Ability to development
- Strong collaboration skills, including but not limited to the ability to create and foster a collaborative work environment, and organize people and resources to solve problems and identify opportunities.
- Strong project management skills, including the ability to manage organizational-wide projects to successful conclusion.
- Very strong assessment and analytical skills, including the ability to synthesize, distill concepts, draw conclusions and identify implications.
- Financial acumen: Interprets and applies understanding of key financial indicators to make better business decisions.
- Strong skills in budget development and management.
- Manages complexity: Makes sense of complex, high quantity, and sometimes contradictory information to effectively solve problems.
- Decision quality: Makes good and timely decisions that keep the organization moving forward.
- Strategic mindset: Sees ahead to future possibilities and translates them into breakthrough strategies; creates, executes and monitors relevant strategic and business plans.
- Advanced financial modeling and analytical skills, including the ability to synthesize, distill concepts, draw conclusions and identify implications.
- Resourcefulness: Secures and deploys resources effectively and efficiently; organizes people and resources to solve problems and identify opportunities.
- Plans and aligns: Plans and prioritizes work for self and others to meet commitments aligned with organization goals.
- Ensures accountability: Holds self and others accountable to meet commitments.
- Drives Results: Consistently achieves results, even under tough circumstances.
- Strong interpersonal skills, including the ability to establish and maintain effective working relationships with individuals at all levels inside and outside of HPSJ.
- Strong oral and written communication skills, including the ability to communicate professionally both orally and in writing to diverse individuals and groups inside and outside of the HPSJ; includes the ability to effectively explain complex information.
- Advanced presentation skills, including but not limited to the ability to tailor presentations to a specific audience, be persuasive and identify key messages.
- Builds networks: Effectively builds formal and informal relationship networks inside and outside of the organization.
- Organizational savvy: Maneuvers comfortably through complex policy, process and people-related organizational dynamics.
- Persuades: Uses compelling arguments to gain the support and commitment of others.
- Manages ambiguity: Operates effectively, even when things are not certain or the way forward is not clear.
- Demonstrated ability to articulate and support HPSJ’s vision, mission, values and strategy, integrate into management practices, and foster their manifestation among staff.
- Demonstrated leadership abilities to interact effectively and collaboratively with people across organizational boundaries and influence without power in a matrixed management environment.
- Ability to supervise staff in a manner that maximizes employee performance and business results, which includes very strong coaching/counseling skills and ability to function as a mentor.
- Ability to speak and be understood in English.
- Ability to handle confidential information with appropriate discretion.
Required Experience
WHAT YOU HAVE:
EDUCATION AND EXPERIENCE
Required
- Bachelor’s degree in Health or Business Administration or related field; and
- At least 3 to 6 years of experience of in Medicare Advantage and/or D-SNP health plan operations; and
- At least seven years of experience in a management position of a health insurance plan, IPA, managed care organization, or public agency serving related populations; and
- At least six years of supervisory experience.
- Project management experience
Preferred
- Master’s degree in Health or Business Administration or related field
- Medi-Cal managed care experience
WHAT YOU WILL GET:
- HPSJ Perks:
- Competitive salary
- Robust and affordable health/dental/vision (90% paid medical for employees and 100% paid dental/vision for employees) with choices in providers
- Generous paid time off (starting at 3 weeks of PTO, 4 paid floating holidays including employee’s birthday, and 9 paid holidays)
- CalPERS retirement pension program, automatic employer-paid retirements contributions, in addition to voluntary defined contribution plan
- Two flexible spending accounts (FSAs)
- Employer-Paid Term Life and AD&D Insurance
- Employer-Paid Disability Insurance
- Employer-Paid Life Assistance Program
- Health Advocacy
- Supplemental medical, legal, identity theft protection
- Access to exclusive discount mall
- Education and training reimbursement in addition to employer-paid elective learning courses.
- A chance to work for an organization that is mission-driven – our members and community are at the core of everything we do.
- A shorter commute – if you’re commuting from the Central Valley to the Bay Area.
- Visibility and variety – you have a chance to work with people at all levels of the organization, and work on diverse projects.
OUR VISION:
- Continuously improve the health of our community.
OUR MISSION:
- We provide healthcare value and advance wellness through community partnerships.