Director, Medicare

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To protect the health and well-being of our members, employees and community, CareOregon requires all employees to be fully vaccinated against COVID-19 or have an approved medical or religious exception as a qualification of employment.

Candidates who receive an offer of employment by CareOregon, must provide proof of COVID-19 vaccination or submit a medical or religious exception request, which will be evaluated in accordance with CareOregon’s standard accommodation process.

Job Summary

The Medicare Director is responsible for directing strategic activities for the Medicare line of business for the organization. Primary duties include strategic and operational planning and oversight, as well as resource, relationship, and people management. This includes focus on strategic account management and contractual requirements for CMS and OHA and collaboration with internal teams. This position also provides input into strategic plans for the broader organization.

Essential Responsibilities

Technical/Operational Leadership

Directs Medicare Advantage activities across the organization.
Leads CMS Bid preparation, oversight of actuarial contractor, and coordination of internal teams responsible for execution of the annual bid.
Plans and oversees execution of all CMS and OHA reporting.
Serves as the primary liaison between government agencies and internal business units.
Leads benefit design work, including coordination with member engagement and clinical teams to discern member/network needs.
Leads the execution of Medicare initiatives, policies, plans, and goals in alignment with organizational vision and goals.
Provides program oversight to help ensure the goals of the Triple Aim are met or exceeded; builds organizational capability to help succeed in meeting goals.
Provides oversight of operational teams to ensure effective and compliant performance of the plan.
Promotes and ensures internal coordination between Medicare department and Quality, Network, Clinical, and Operations teams.
Works with Medicare Medical Director and clinical outreach teams to track, manage, and coordinate Model of Care submissions and implementation, provider education and communication plans, and internal training and education related to MOC.
Partners with operational teams, including analytics, enrollment, provider relations, and quality improvement, to best meet compliance, organizational and member needs.
Develops and regularly monitors and reports on performance against metrics.
Leads innovation, process review, and improvement efforts.
Reviews and interprets data; participates in complex analysis as needed.
May serve as a sponsor or chair for key projects and initiatives.

Strategic/Operational Planning

Participates in the development of vision and goals, and strategic plans for the Medicare team.
Develops long-term plans and policies.
Provides leadership to program staff to develop short-term operations plans, as well as development and execution of standard operating procedures.
Provides input into strategic plans for the organization with Vice President of Medicare.
Maintains a business unit view while establishing department priorities, being cognizant of broader business unit and organizational impacts.

Financial/Resource Management

Recommends budgets in alignment with short and long-term plans.
Manages resources to ensure priorities are accomplished.
Approves resource allocations within budget, including people, finances, and timelines.

Relationship Management

Leads effective communication system for work group(s), ensuring a collaborative culture.
Builds and ensures effective relationships across internal teams and external organizations for current or future integration.
Partners with internal leaders and managers in identifying improvement plans and processes.
Represents CareOregon in external meetings and functions, providing productive leadership presence and effectiveness.
Interfaces with and oversees regulators, vendors and other outside parties.

People Management

Directs team(s) and establishes team direction and goals in alignment with the organizational mission, vision, and values.
Identifies work and staffing models; recruits, hires, and oversees a team to meet work needs, using an equity, diversity, and inclusion lens.
Identifies department priorities; ensures employees have information and resources to meet job expectations.
Leads the development, communication, and oversight of team and individual goals; ensures goals, expectations, and standards are clearly understood by staff.
Manages, coaches, motivates, and guides employees; promotes employee development.
Incorporates guidance from CareOregon equity tools into people leadership, planning, operations, evaluation, budgeting, resource allocation, and decision making.
Ensures team adheres to department and organizational standards, policies, and procedures.
Evaluates employee performance and provides regular feedback to support success; recognizes strong performance and addresses performance gaps and accountability (corrective action).
Performs supervisory tasks in collaboration with Human Resources as needed.

Organizational Responsibilities
Perform work in alignment with the organization’s mission, vision, and values.
Support the organization’s commitment to equity, diversity, and inclusion by fostering a culture of open mindedness, cultural awareness, compassion, and respect for all individuals.
Strive to meet annual business goals in support the organization’s strategic goals.
Adhere to the organization’s policies, procedures, and other relevant compliance needs.
Perform other duties as needed.

Knowledge, Skills and Abilities Required

Thorough understanding of Medicare rules and requirements, as well as Oregon state regulations
Ability to obtain knowledge of current practices of managed care, competitive market environment, and changes in Medicare regulations, and to assimilate into appropriate plans
Understanding of the Medicare Bid process, design of supplemental benefit plans, Model of Care design and implementation, and CMS compliance
Strong organizational skills and ability to manage and track multiple project plans at one time
Excellent interpersonal, communication and public speaking skills
Ability to influence others without direct authority and negotiate favorable outcomes
Ability to take complex ideas and processes and communicate them in a clear and concise manner
Ability to interact effectively with executive leadership and management
Strong project, program planning, management and evaluation skills
Advanced Excel, Word and PowerPoint skills
Effective at dealing with conflict and opposing objectives
Ability to think strategically
Ability to lead and motivate staff
Analytical and critical thinking skills
Ability to manage multiple and competing tasks and priorities
Ability to work in a culturally, and professionally, diverse work environment

Physical Skills and Abilities Required
Lifting/Carrying up to 0 Pounds

Pushing/Pulling up to 0 Pounds

Pinching/Retrieving Small Objects

Crouching/Crawling

Reaching Above Shoulders

Climbing Stairs

Repetitive Finger/Wrist/Elbow/

Shoulder/Neck Movement

0 hours/day

0 hours/day

0 hours/day

0 hours/day

0 hours/day

0 hours/day

3-6 hours/day

Standing

Walking

Sitting

Bending

Seeing

Reading

Hearing

Speaking Clearly

0 hours/day

0 hours/day

0 hours/day

0 hours/day

More than 6 hours/day

More than 6 hours/day

3-6 hours/day

3-6 hours/day

Cognitive and Other Skills and Abilities Required

Ability to focus on and comprehend information, learn new skills and abilities, assess a situation and seek or determine appropriate resolution, accept managerial direction and feedback, and tolerate and manage stress.

Education and/or Experience

Required:

Minimum 10 years related experience, including minimum 5 years’ experience in managed care
Minimum 4 years’ experience in a supervisory position
Preferred:

Experience with the dual eligible population

Working Conditions

Environment: This position’s primary responsibilities typically take place in the following environment(s) (check all that apply on a regular basis):
☒ Inside/office ☐ Clinics/health facilities ☐ Member homes

☐ Other_________________________________________

Travel: This position may include occasional required or optional travel outside of the workplace, in which the employee’s personal vehicle, local transit, or other means of transportation may be used.
Equipment: General office equipment
Hazards: n/a
Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment

Veterans are strongly encouraged to apply.

Equal opportunity employer. This company considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.

Position Description »