Medicare Advantage Program Manager

ROLE AND RESPONSIBILITIES

Under the direction of the VP of Medical Management, the Medicare Advantage Program Manager is responsible for managing the Managed Medicare product for assigned Provider Network partnering with the Accountable Care Organization (ACO). As the business owner for this product the incumbent will lead the strategic direction, including design and execution, of the Medicare Advantage care model. This role partners closely with Care Management Operations and Compliance to implement care model strategies, ensure ongoing efficiencies and compliance.

CORE FUNCTIONS

  • Provides leadership and administrative oversight, program development, implementation and evaluation of the Medicare Advantage Program

  • Manages, plans and directs the overall operation of the program including oversight of all clinical staff

  • Responsible for the execution, performance and implementation of program changes in compliance with regulatory agencies

  • Monitors, manages and influences the clinical product profit and loss

  • Provider Group management - overall management of assigned Provider Groups; fostering an environment of strong positive relationships and performance

  • Proactively identify Provider Group’s needs, resolving and communicating concerns or complaints regarding ACO Managed Care programs to maintain Provider Group satisfaction

  • Strategic planning with ACO Managed Care provider groups to drive enrollment numbers

  • Responsible for coordinating and facilitating all meetings with Managed Care Provider Group’s Office Managers

  • Coordinate with Management to bring innovative processes, reporting, and communication integration for all Provider Groups

  • Subject matter expert in Managed Medicare Star Ratings, Risk Adjustment and overall framework of the Managed Medicare product

  • Identify opportunities for improved processes and Provider Group participation in established ACO Managed Care programs

  • Assure that all Provider Group’s trainings, reporting, compliance and site visits are completed within established time frames

  • Continuous mindset toward efficiency and process improvement – how to apply technology and processes to improve delivery and efficiency from both the Provider Group and internal perspective

  • Complete all provider orientations and site visits within designated time frames

  • Professionally represent the organization at all times; support the mission, goals and objectives; participate as a ‘team player”, constantly supporting other managers; set an example of high personal and professional conduct for employees and others

  •  Selects, develops, and leads Program Coordinator department personnel

  • Understands management needs and applies consultative problem-solving skills for long-term and day-to-day issues

QUALIFICATIONS AND EDUCATION REQUIREMENTS

  • Registered Nurse License

  • Bachelor’s degree (BSN)

  • Successful outcomes in program management of Medicare advantage programs

  • 1 years experience in a physician’s office

  • Strong client focus (provide examples of success)

  • Value relationships; demonstrate professional respect and innovative mindset

  • Confident working with heath care professionals

  • Passionate about your work and move forward with purpose; demonstrate clear value and support of your Provider Groups and internal teams

  • Exercise judgment in order to problem solve when the answer is not readily apparent

  • Approach problem solving that involves systems thinking – understanding how the process works and how people are impacted by your decisions

  • Strong communication skills – understanding the need for being inclusive for effective results; communicate effectively with both day to day operational resources and executive management

  • Understand sense of urgency, fast-paced and multi-tasking environment; strong organizational skills

  • Solutions oriented, willing to bring Provider Groups results regardless of roles or titles

  • Requires daily local travel to provider offices (mileage reimbursement provided)

  • Willingness and ability to attend after hour business meetings as needed

  • Must maintain valid driver’s license and use personal vehicle for travel

  • Experience with basic Microsoft Office Applications


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