Director - Medicare Advantage Operations

8 - 10 years experience  •  Healthcare

Salary depends on experience
Posted on 06/29/18
8 - 10 years experience
Healthcare
Salary depends on experience
Posted on 06/29/18

Prominence Health Plan, established in Reno in 1993 as St. Mary’s Health Plan, was acquired in 2014 by Universal Health Services (UHS), one of Fortune Most Admired Companies. 

In addition to the HMO, Prominence Health Plan also offers Point of Service health plans, a preferred health insurance company that offers Preferred Provider Organization (PPO) health plans, and CDS Group Health, a third-party administrator.

We are a fast-growing, rapidly-changing healthcare organization offering the excitement of a start-up with the support of a Fortune 500 company. We are looking for talented, enthusiastic people to help shape the future of our organization.

Job Summary:  The Director, Medicare Advantage has accountability for Medicare Advantage operations working cooperatively with internal functional areas and contracted partners. The Director will hold product accountability for all aspects of the Medicare Advantage product in all markets and works with the Medicare Compliance Officer to monitor the compliance program.  The Director will serve as subject matter expert and public spokesperson on all Medicare Advantage matters, serve as the CMS contact person, and participate in the strategy development within Prominence and UHS that will shape the expansion of Medicare Advantage to other markets and additional products.  The Director will manage the bid process, lead operational strategies and tactics to achieve at least a 4 Star rating, ensure appropriate risk scores, and achieve NCQA accreditation for the Medicare Advantage product. The incumbent will be responsible to identify staffing, logistics, technical, and programmatic resources needed within Prominence to build the necessary capacity and capability within budgetary guidelines.

Requirements

Regulatory Requirements:

 

  • Bachelor’s degree in Health Administration, Business or related field.  Master’s preferred

     

  • Seven + years’ experience in  Medicare Advantage operations in a health plan setting

     

  • Significant Medicare Advantage operations leadership experience with proven track record of building Medicare Advantage programs.

 

 

Language Skills:

 

  • Ability to effectively communicate in English, both verbally and in writing.
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