Medicare Program Manager

Summary

Join the Central California Alliance for Health as the Medicare STARS Program Manager! Reporting to the Medicare Program Executive Director, you will be responsible for program planning, data analysis, and collaboration with internal and external stakeholders to optimize STARS ratings. The ideal candidate thrives in a matrix environment and possesses extensive experience in Medicare Advantage/D-SNP programs. A Master's degree in a related field and experience with Medi-Cal products are required. The Alliance offers a hybrid work environment and a comprehensive benefits package, including medical, dental, vision, ample paid time off, and retirement plans.

Requirements

• Thrive in a matrix management environment
• Proven track record of executing effective business strategies with the ability to execute and deliver results for Medicare Advantage and/or D-SNP programs
• Comprehensive program planning and development, management, and evaluation skills
• Demonstrated leadership skills with the ability to influence and motivate team members and peers to achieve program goals and objectives
• Demonstrated skill in critical thinking, with the ability to interpret complex Medicare requirements and implement them into business operations
• Champion change management to adopt new programs, policies & processes for seamless integration with current operations
• Excellent project management and interpersonal skills with emphasis on collaboration
• Excellent written and verbal communication and presentation skills
• Master’s degree in Business, Health Administration, Public Policy or a related field
• Experience working with Medi-Cal products
• Knowledge of: Principles and practices of Medicare managed care operations and related regulations
• Knowledge of: CMS D-SNP STARS Rating System
• Knowledge of: Complex practices, issues, and theoretical principles related to Medicare Advantage or D-SNP, including the market and regulatory environment
• Knowledge of: Principles and practices of program development, implementation, management, and evaluation
• Knowledge of: Research, analysis, and reporting methods
• Ability to: Communicate STARS Rating System requirements and their impacts on Alliance operational systems
• Ability to: Develop and implement tactics based on the overall STARS strategy
• Ability to: Work effectively with cross-functional teams and build strong relationships with stakeholders
• Ability to: Demonstrate strong analytical skills, accurately collect, manage and analyze data, identify issues, offer recommendations and potential consequences, and mitigate risk
• Ability to: Manage multiple projects simultaneously, organize work, and achieve goals and timelines
• Education and Experience: Bachelor’s degree in Business, Healthcare Administration, Public Policy, or a related field
• Education and Experience: A minimum of eight years of experience in a managed care setting which included a minimum of five years of experience in Quality Improvement program/project management and a minimum of three years of experience working with the CMS D-SNP STARS Rating System (a Master’s degree may substitute for two years of the general managed care experience); or an equivalent combination of education and experience may be qualifying

Responsibilities

• Perform program planning and design in support of development and implementation of the Alliance’s STARS Program and perform ongoing operational program management
• Perform data analysis and reporting in support of STARS Program activities
• Work collaboratively with all Alliance departments and external stakeholders to maximize STARS ratings

Benefits

• Medical, Dental and Vision Plans
• Ample Paid Time Off
• 12 Paid Holidays per year
• 401(a) Retirement Plan
• 457 Deferred Compensation Plan
• Robust Health and Wellness Program
• Onsite EV Charging Stations