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Director, Medicare Operations

Maumee, Ohio; Cincinnati, Ohio; Cleveland, Ohio; Evansville, Indiana; Columbus, Ohio
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Description

Position Summary

This position is responsible for developing and implementing operational relationships, quality controls, strategies and efficiencies/workflows deliver best in class Medicare products and service.  The Director, Medicare Operations ensures that Paramount’s Medicare product line goals including P and L responsibilities, strategic plan objectives, and standards are met, and that all governmental regulations and plan policies and procedures are consistently administered across Paramount.  Oversee that all departmental projects are timely, accurately and with appropriate approvals.

 

Accountabilities

1.    Direct and indirect oversight of daily operations for all Medicare product lines
2.    Development of a competitive pricing strategy and benefits for Paramount Medicare plans, including oversight of the annual bid process
3.    Ensures compliance will all applicable statutes and regulations and maintains collaborative relationships with federal and state agencies
4.    Plans and executes the development of new products and markets
5.    Prepares annual department budgets and reports outlining Department activities, actual vs. expected performance, identification of potential problem areas and opportunities for improvements
6.    Provides oversight and operations support for ongoing plan audits; monitoring tasks and compliance submissions to regulatory entities
7.    Works cooperatively with other department staff and managers to meet interdepartmental needs and coordinates interdepartmental activities
 


  • Education: Bachelor’s Degree or 15 years of experience in a health plan or CMS. 
  • Skills:
    • Demonstrated strengths in problem-solving, analysis and organizational skills, excellent oral and written communication skills, and effective interpersonal skills.
    • Ability to plan, coordinate and organize multiple priorities and to work independently.
    • Knowledge of the Medicare program, health care delivery systems, CPT coding, and medical terminology required.  
    • Experience in using a computer for spreadsheets and word processing required.  
  • Years of Experience:
    • 5-7 year of healthcare industry experience and a minimum of three years of experience working within a health plan or provider organization on Medicare matters.
    • Must have at least 3 years of prior leadership experience. 
  • License: Valid driver’s license and ability to travel independently throughout Plan’s current and future service area.

 

 

Preferred Qualifications

  • Education: Master’s Degree
  • Skills: Ability to interact successfully interact with regulators, providers and senior level administrators on a regular basis.
  • Years of Experience: 10+ years of healthcare industry experience and management; 2+ years managing a team of 5 or more individuals; 5 years managerial experience in Medicare programs with a solid understanding of Medicare products; demonstrated experience with marketing/sales, regulatory compliance, plan benefits and administration

 

Physical Demands: Sitting for extended periods of time, dexterity of hands and fingers to operate a computer keyboard, mouse, and phone, travel capabilities that requires individual mode of transportation to visit client locations and team events, requires carrying a laptop to meeting locations

Work Environment and Environmental Condition: Normal office environment with open office concept, travel in vehicle and occasional overnight stays, no hazardous chemicals.

 

 

ProMedica is a mission-based, not-for-profit integrated healthcare organizational headquartered in Toledo, Ohio.  For more information, please visit www.promedica.org/about-promedica

Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or any other legally protected category. In compliance with the Americans with Disabilities Act Amendment Act (ADAAA), if you have a disability and would like to request an accommodation in order to apply for a job with ProMedica, please contact employment@promedica.org

Equal Opportunity Employer/Drug-Free Workplace

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