EmblemHealth

Medicare Perf. Mgmt. & Transformation Dir.

EmblemHealth • $130K — $180K *
New York, NY 10025In-Person
Healthcare
8 - 10 years of experience
3 days ago
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Job Overview by Ladders

Qualifications

  • Bachelor's degree in business, Finance, HealthCare Administration or related field; MBA preferred.
  • 10-12+ years in healthcare, with increasing responsibility.
  • 5+ years of Medicare experience (products, regulations, economics).
  • 4+ years in management consulting or structured problem-solving environment.
  • Strong financial acumen including P&L tracking and forecasting.

Responsibilities

  • Lead Medicare performance management by integrating data, insights, and execution.
  • Translate complex analytics into clear, actionable insights for strategic decision-making.
  • Drive performance improvement through governance, performance reporting, and execution.
  • Develop executive-level presentations that clarify risks and opportunities.
  • Establish priorities and project plans to ensure delivery of results across teams.
  • Support strategy development with assessments and prioritization frameworks.
  • Analyze sales channel performance to inform growth strategy.

Benefits

  • Flexible work environment with remote options.
  • Opportunities for professional development and continuing education.
  • Access to wellness programs and health benefits.
  • Collaborative and inclusive company culture.
Full Job Description
Summary of Position
  • Lead Medicare performance management by connecting strategy and execution; and integrating data, insights, and execution across financial, operational, quality, and growth dimensions.
  • Translate complex analytics into clear priorities, executive-ready insights, and actionable recommendations to support strategic and operational decision-making.
  • Serve as a key partner in the development and execution of Medicare strategy - shaping priorities, investments, and long term direction.
  • Drive performance improvement and remediation through structured governance, performance reporting (KPIs, dashboards), and disciplined execution across functional teams.
  • Ensure the Medicare business is financially sound, operationally reliable, compliant and market competitive.


Principal Accountabilities
  • Lead Medicare Performance Management & Reporting: define, monitor and evolve Key Performance Indicators (KPIs) and develop enterprise dashboards and scorecards aligned to Medicare segment goals and establish transparent reporting to communicate goals and execution across the organization.
  • Drive Performance Improvement & Remediation: conduct gap analyses; identify root causes; partner with functional teams to design, prioritize, and track remediation initiatives with measurable outcomes.
  • Develop Executive Insights & Presentations: translate complex analyses into clear, concise executive-level presentations, including risks, opportunities and recommendations.
  • Lead Cross-Functional Execution & Governance; chair performance governance forums; align stakeholders; establish priorities; develop project plans and ensure milestone tracking, accountability and delivery of results.
  • Provide Strategic Execution Support Across Priority Gaps: flex into high-priority areas requiring additional leadership or analytical support; rapidly assess issues and drive execution to address performance or capability gaps.
  • Build Strategic & Prioritization Frameworks: support strategy development through strategic assessments, prioritization frameworks, and structured evaluation of initiatives and investments.
  • Support Sales, Product & Competitive Performance Analysis: evaluate sales channel performance, enrollment forecasting, product competitiveness, and market positioning to inform growth and product strategy.


Qualifications

Education, Training, Licenses, Certifications
  • Bachelor's degree in business, Finance, HealthCare Administration, or related field; master's (MBA) preferred.
  • Project Management certification (PMI) preferred.


Relevant Work Experience, Knowledge, Skills, and Abilities
  • 10 - 12+ years of progressive experience in healthcare, with increasing scope and responsibility.
  • 5+ years of Medicare experience (products, regulations, economics, competitors).
  • 4+ years in management consulting or equivalent structured problem-solving environment.
  • Deep understanding of Medicare P&L and key performance drivers.
  • Experience across Medicare product types (MA, SNP, EGWP, PDP, Med Supp).
  • Proven ability to develop and effectively utilize tables, dashboards, and performance scorecards.
  • Experience conducting gap analysis, performance diagnostics, and strategic assessments.
  • Experience developing prioritization frameworks and business cases.
  • Strong financial acumen including P&L tracking and enrollment forecasting.
  • Experience leveraging internal and external data sources (e.g., CMS data, trend reports, primary and secondary research) to drive actionable insights.
  • Ability to translate complex data into clear, decision-ready insights for executive audiences.
  • Proven ability to lead complex, cross-functional initiatives with project plans and milestone tracking.
  • Strong communication and storytelling skills; ability to influence at all levels.
  • Ability to operate effectively in a matrixed organization without direct authority.
  • Experience managing people, processes, or project teams.
  • Advanced proficiency in Excel.
  • Experience with Access, SQL, or similar data tools.
  • Expertise in PowerPoint and executive-level presentation development.
  • Enthusiasm for engaging with AI solutions (e.g., Co-Pilot) to enhance and expedite all deliverables.

About EmblemHealth

EmblemHealth is a non-profit health insurance company based in New York City. It is one of the largest non-profit health insurers in the United States, serving over 3 million people. EmblemHealth offers a range of health insurance plans, including HMO, PPO, and EPO plans, as well as Medicare and Medicaid plans. The company also offers wellness programs and disease management services. EmblemHealth was formed in 2006 through the merger of Group Health Incorporated (GHI) and the Health Insurance Plan of Greater New York (HIP). The company has offices in New York City and Albany, New York.
Learn more about EmblemHealth
Size
3,000 employees
Industry
Healthcare
Net Income
-$100 million
Founded
2006
5 Year Trend
-5%
Revenue
$10 billion
NASDAQ
* Ladders Estimates

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