Manager, Medicare Programs

Are you looking to leverage your leadership and strategic healthcare knowledge to build a new line of business?

Reporting to the Director, Medicare Product you will have responsibility for supporting leadership and staff in the development and launch of San Francisco Health Plan’s Medicare Dual Special Needs Plan (D-SNP) as well as the ongoing compliance and high-quality operational performance of staff and the program.

Leveraging your leadership acumen, you will lead and manage the team in operational planning, serve as a Medicare subject matter expert and, in collaboration with operational leaders, provide recommendations on process improvements and lead the program(s) to meet critical compliance and operational needs.

Please note – while this position classified as a hybrid role, it will require an on-site, in-office presence 4 days per month.

• Bring Medicare knowledge and experience, support SFHP’s D-SNP operating model, and drive planning and implementation efforts.
• Support functional decision making in building a Medicare program by sharing expertise of industry best practices and facilitating tactical workstreams.
• Support internal stakeholders in the identification, development, planning, and implementation of short- and long-term strategies to support the launch of our D-SNP product.
• Serve as an internal subject matter expert (SME) and ensure readiness of D-SNP operational functions and performance (e.g., Marketing, Sales, Enrollment, Risk Adjustment, STARs).
• In collaboration with our Enterprise Project Management Office, support the development of project plans, operational and performance readiness plans, and timelines to support a successful D-SNP product launch.
• Coordinate network adequacy reporting and documentation with Provider Services and other departments to ensure that plan meets all network adequacy standards for the application and on an ongoing basis.
• Collaborate with Member Services to develop and implement an operational strategy for D-SNP Customer Services and Grievances and Appeals functions.
• Develop internal communication documents and Medicare training criteria for SFHP employees and first tier downstream entities.
• Support Medicare program development with requirements gathering, business case creation, and improvement plans.
• Contribute to and/or lead detailed data analysis.
• Support functional teams through information exchange, training, and collaboration
Longer Term
• Promote increased program efficiency, service levels, and value by capturing and monitoring performance, and then identifying opportunities for improvement and strategies to realize those opportunities.
• Identify D-SNP product opportunities based on analysis of SFHP’s dual eligible population and the market landscape.
• Manage the annual Medicare/D-SNP plan benefit package design and application(s) process.
• Manage and apply product development lifecycle to the application process, bid development, benefit designs, member materials, and go-to-market strategy.
• In collaboration with our Marketing & Communications function, provide centralized year-round support in Medicare for the development and editing of core beneficiary communications, to include the Medicare Summary of Benefits and Annual Notice of Change/Evidence of Coverage for print and online distribution, ensuring compliance with CMS guidelines.
• Identify opportunities to increase efficiency, improve service levels and to ensure regulatory compliance through enhanced operations
• Actively collaborate with people who are responsible for internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion. Monitor projects from inception through delivery.

• Bachelor’s Degree or equivalent combination of education/experience.
* Masters degree preferred.
• 10 or more years experience in product development, process improvement and/or product management, ideally within a Medicare environment.
• 3 or more years of leadership (people management) experience.
• 2 or more years experience developing or implementing operational Medicare components.
• Knowledge of state and federal managed care program requirements, including Medi-Cal and Medicare health care laws.
• Ability to successfully lead a team and communicate effectively with staff, management and executives.
• Familiar with health care, managed care terminology, or Medi-Cal.
• Strong organization, time management and project management skills and multi-tasking abilities.
• Advanced analytical skills and problem-solving skills with the ability to formulate and communicate recommendations for improvement.
• Demonstrated proficiency with MS Office (Word, Excel, Outlook, Powerpoint) and shared document repositories (i.e., Sharepoint).

A competitive and robust compensation package, including:
• Health benefits – several plan choices to cover you and your dependents medical, dental, vision needs
• Retirement – Employer-matched CalPERS Pension and 401(a) plans, 457 Plan
• Time off – 23 days of Paid Time Off (PTO) and 13 paid holidays
• An opportunity to work in a vibrant atmosphere with the most amazingly talented people who are shaping the future of healthcare!
The chance to make a difference in the lives of many San Francisco residents

Established in 1997, San Francisco Health Plan (SFHP) is an award winning, managed care health plan whose mission is to provide affordable health care coverage to the underserved low and moderate-income residents in San Francisco county. SFHP is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees and its 175,000+ members have access to a full spectrum of medical services including preventive care, specialty care, hospitalization, prescription drugs, and family planning services. SFHP was designed by and for the residents it serves and takes great pride in its ability to accommodate a diverse population that includes young adults, seniors, and people with disabilities.

San Francisco Health Plan is proud to be an equal opportunity employer. We are committed to a work environment that supports and respects all individuals and in which our processes are applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, or other protected characteristics.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

San Francisco Health Plan is an E-Verify participating employer.

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