Job Description:

Public Partnerships Manager, Medicare

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Reporting to the Vice President of Public Partnerships, the Public Partnerships Manager will be responsible for overseeing compliance with state and federal regulations and contracting. Primarily overseeing the Senior Care Options (SCO) contract and reporting deliverables, this role will also manage the Plan's overall relationship with state regulators and other government agencies including the Massachusetts Executive Office of Health and Human Services (EOHHS) and Centers for Medicare and Medicaid Services (CMS). Additionally, this role will be accountable for working with the Plan's business units and owners, including the Medicare Product Team, to ensure internal collaboration as well as cross-functional implementation and integration of the SCO contract and regulatory policies and procedures. Lastly, the Public Partnerships Manager will be charged with overseeing regulatory and contractual compliance for future Medicare products offered by the Plan.

Key Functions/Responsibilities:

• Serves as the Plan's key contact and primary liaison with and manages the day-to-day relationship with EOHHS and other state or federal agencies, including Plan responses to requests from EOHHS or CMS.


• Oversees and ensures the timely completion and quality of deliverables related to contract requirements as well as program and policy changes.


• Responsible for the collection, analysis, accuracy and submission of all EOHHS and other state and federal based contractual or regulatory reports for SCO (in collaboration with the Pubic Partnerships Senior Reporting Analyst).


• Leads and coordinates implementation of contract amendments, working with the affected internal business areas.


• Works in close collaboration with the Medicare Compliance Officer to maintain alignment with CMS and EOHHS requirements and monitors local and national regulatory development, working with Plan business owners, Legal, and Compliance to ensure clear interpretation and timely implementation.


• Provides contract and regulatory guidance to internal business units to help address and resolve complex program related issues and escalations.


• In partnership with the Plan's Medicare Product Team, identifies new opportunities, implement new processes and/or determine needed areas of improvements to existing processes to support optimal program performance and adherence to contractual and regulatory requirements.


• As directed by the VP or Director of Public Partnerships, supports Plan senior and executive leadership on initiatives and projects related to any Medicare (or Medicaid) programs, expansions, procurements.

Qualifications:

Education:

• Bachelor's Degree in Legal Studies, Health Care Administration, Public Administration, Public Health, Business Administration, Government Relations, Social Sciences or related field. Candidates who do not meet the educational requirement but possess the appropriate combination of experience and training will be considered.Seven or more years of experience in health care/health care insurance organization, managed care, Medicare, Medicaid, or Public Exchange product management.


• Demonstrated ability to build and lead effective teams and successfully plan, organize and manage initiatives/projects.


• Experience with data analysis, data interpretation and data driven decision making.

Experience:

• Seven or more years of experience in health care/health care insurance organization, managed care, Medicare, Medicaid, or Public Exchange product management.


• Demonstrated ability to build and lead effective teams and successfully plan, organize and manage initiatives/projects.


• Experience with data analysis, data interpretation and data driven decision making.

Preferred:

• Master's degree in Health Care Administration, Public Administration, Public Health, Business Administration or Government Relations.


• Prior experience working on Medicare related or SCO programming.


• Project management experience.

Competencies, Skills, and Attributes:

• Ability to effectively and clearly communicate issues, findings, and recommendation both verbally and in writing to all levels of management, including executive staff, and external stakeholders such as regulatory agencies.


• Confident taking ownership of work streams with high-level direction and guidance, and producing proposed plans of action in a self-driven manner.


• Ability to navigate complex, matrixed organizations, with a collaborative approach to problem-solving and performance improvement.


• Experience managing implementation or performance improvement projects, including producing work plans and managing to them.


• Strong background in health insurance, Medicaid, Medicare, Affordable Care Act, federal Demonstration programs and managed care.


• Ability to effectively communicate issues, findings, and recommendations both verbally and in writing to all levels of management, external stakeholders, and regulatory agencies.


• Ability to build relationships and alliances and successfully to interact within all levels of the organization and external stakeholders.


• Excellent business writing, proof reading and editing skills.


• Effective analytical, consulting skills and leadership skills.


• Strong focus on service to internal and external customers.


• Ability to prioritize and organize work and to multi-task when required.


• Ability to work independently and collaboratively, manage multiple projects and meet goals and scheduled deadlines.


• A strong working knowledge of Microsoft Office products, including Excel and Access.


• Experience with MS Project and Visio a plus.

Working Conditions and Physical Effort:

• Ability to work some extended hours during peak periods

*Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.