Manager, Medicare Administration

What you can expect! 

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!

In collaboration with operational leaders, the Manager of Medicare Administration will lead the development, implementation, and maintenance of operational policies and strategies that support Medicare Advantage (MA) supplemental benefits (including, but not limited to, management of the flex card capabilities/functionality, flex card vendor performance, annual VBID and bid renewals, and other Part C requirements). The Manager of Medicare Administration will also evaluate and report the results of implemented supplemental benefit strategies.  This role is responsible for facilitation of a multi-functional team to develop comprehensive MA member retention plan. In addition, the Manager of Medicare Administration will manage all aspects of the DSNP Enrollee Advisory Committee (EAC), ensuring compliance with Medicare requirements.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members; we also aim to match our Team Members with the same energy by providing prime benefits and more.

• CalPERS retirement
• 457(b) option with a contribution match
• Generous paid time off- vacation, holidays, sick
• State of the art fitness center on-site
• Medical Insurance with Dental and Vision
• Paid life insurance for employees with additional options
• Short-term, and long-term disability options
• Pet care insurance
• Flexible Spending Account – Health Care/Childcare
• Wellness programs that promote a healthy work-life balance
• Career advancement opportunities and professional development
• Competitive salary with annual merit increase
• Team bonus opportunities

1. Develop and lead the implementation and maintenance of policies, strategies and practices that are in the best interest of Medicare Advantage supplemental benefits operational and financial stability including annual VBID and bid renewals, and other Part C requirements.
2. Work closely with Product Development, Actuarial Services, Health Services, Quality, Pharmacy and Sales teams to develop bid recommendations to align with organizational Medicare goals and strategies. Recommend strategic changes, if necessary, to improve the program results.
3. Provide ad hoc research and analysis to support bid development. Conduct competitive/market analysis in conjunction with Product Management.
4. Collaborate with Finance and Compliance in planning, developing, and submitting the Medicare VIBD and bid as necessary in a timely and thorough manner. Work with Compliance to complete required application information, identify dependencies requiring information from other functional areas, and managing the collection of that data/information
5. Responsible for end-to-end accountability for benefit implementation, ongoing administration, and benefit performance (including flex card/portal services, access, ease of member use). Ensure service areas and associated functions clearly understand benefit, usage policy, access, and vendor responsibilities.
6. Lead workgroups across the organization in developing and implementing a methodology for evaluating the effectiveness of supplemental benefit and program strategies and activities. Includes monitoring of the supplemental benefit/program performance, utilization, and regulatory reporting.
7. Work with external vendor(s), in planning, implementing, and maintaining supplemental benefits (integrations between IEHP and vendor processes/systems, network development, and development of business requirements), and manage the terms of the vendor service agreement.
8. Develop and oversee the DSNP Enrollee Advisory Committee. Recruitment and selection of member committee, IEHP, and community partners to support the IEHP DSNP program.
9. Facilitate a multi-functional team to develop a comprehensive member retention plan. Develop strategies to retain members based on termination drivers. Develop monitoring and reporting processes; define KPIs and communicate progress to the greater organization.
10. Manage Medicare Administrations team; provide training and skills development to support the overall MA supplemental benefits and product strategy.
11. Responsible for any other duties as required ensuring Health Plan operations are successful.

Education & Experience

• Five (5) years of relevant work experience managing Medicare Advantage plans or other relevant Medicare product experience required. Proven leadership experience, mentoring, and developing a team at a leadership level required.
• Bachelor’s degree in Business Administration, Public Health, Public Policy, or related field from an accredited institution required.

Key Qualifications

• Must have a valid California Driver’s license.
• Knowledge of managed care is required. Knowledge of Medicare managed care or Medi-Cal managed care is required. Understanding of and sensitivity to a multi-cultural environment and community.
• Excellent writing, interpersonal, communication, project management and organizational skills.
• Ability to develop collaborative relations with various levels of management throughout IEHP is required. Must have a high degree of patience and attention to detail.

Start your journey towards a thriving future with IEHP and apply TODAY!

This is a hybrid position. Team member will be required to perform onsite work, Tu-Thur. Remote opportunities on Mondays and Fridays.