Executive Director of Medicare job vacancy in Kern Health Systems, (Bakersfield, CA 93308)

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We got a new job details in Kern Health Systems & they are Hiring Candidates for Executive Director of Medicare

Job Details
Company Name :
Kern Health Systems
Company Location :
Bakersfield, CA 93308
Job Position :
Executive Director of Medicare
Job Category :
Jobs in California

Job Description :
We appreciate your interest in our organization and assure you that we are sincerely interested in your qualifications. A clear understanding of your background and work history will help us potentially place you in a position that meets your objectives and those of the organization. Qualified applicants are considered for positions without regard to race, color, religion, sex (including pregnancy, childbirth and breastfeeding, or any related medical conditions), national origin, ancestry, age, marital or veteran status, sexual orientation, gender identity, genetic information, gender expression, military status, or the presence of a non-job related medical condition or disability (mental or physical).
Our Mission.. Kern Health Systems is dedicated to improving the health status of our members through an integrated managed health care delivery system.PRIMARY PURPOSE:
The Executive Director of Medicare provides leadership and direction for the complete lifecycle of the Dual Eligible Special Needs Population (D-SNP) and Medicare product lines. The position is responsible for strategically evaluating, planning and leading complex business initiatives that achieve the strategic product objectives. The Executive Director of Medicare will be responsible for the implementation of regulatory compliance; member satisfaction and growth; achieve financial and operational efficiencies and sustainability; and ensures product integrity while providing excellent service. The Executive Director will take specific responsibility for achieving program financial stability through understanding the market; target market position and growth; competitive landscape, and the comprehensive needs and gaps of the specific line of business.DISTINGUISHING CHARACTERISTICS:
As an industry expert in Medicare managed care and duals products, the Executive Director will be responsible for identifying and driving solutions for program issues impacting member and revenue growth, cost containment, operational performance, and mitigating program risk. The position reports directly to the Chief Executive Officer.
Essential Duties and Responsibilities

Responsible to plan, direct, and oversee all aspects of the KHS D-SNP/Medicare line of business from the initial implementation phase to the continuous operational management.
Provide leadership to assure the effective and efficient operational management of multiple functions and collaboration with departments.
Oversee the planning, development, implementation and launch of all products and develop processes/documentation to educate both internal and external clients/stakeholders on product features.
Stay current with leading industry issues, local environmental conditions, competitive landscape, and changes impacting the population.
Develop product strategy and roadmaps based on market intelligence, customer feedback, differentiating capabilities through close collaboration with other Product Development teams.
Prioritize product development projects based on input from a variety of sources (customer feedback, market research, business need and technology capabilities).
Accountable for the Medicare product roadmap, balancing needs for new features, client deliverables, and market expectations.
Define and drive new business product development opportunities within the market and/or compliance/regulatory requirements and drive for the development of business case/cost benefit analysis/ROI analysis for product governance.
Serve as the Medicare, duals, D-SNP policy subject matter expert related to policy and regulatory requirements.
Responsible for compliance with State and Federal laws, accreditation standards, internal operations, and products, and ensures timely administration/implementation of all regulatory requirements of market expansion filings in accordance with all state and federal guidelines.
Collaborate on: Network development and provider relations; Data reporting for KPIs and monthly financials; Care management and care coordination; Marketing and sales.
Collaborate on: CMS Medicare bid with the financial and actuary team.
Collaborate closely with other departments to ensure appropriate and timely implementation of federal and state regulatory requirements.
Perform other duties as assigned.

Education & Experience:
Master’s degree in health care, public policy, business, or related field required;Seven (7) years of experience in an executive position of a health insurance plan, IPA, managed care organization, medical facility, or public agency serving related populations required.
Preferred Experience:
Medicare Advantage health plan operations & Medicare Advantage HMO SNP experience preferred;Knowledge/Experience in Medicare. Extensive knowledge of the health care marketplace, finical analysis, reimbursement methodologies, and operational analysis;Project management experience strongly preferred
Knowledge of:

Ability to think strategically with the ability to create messaging to influence desired outcomes.
Ability to interpret CMS communications including memos, guidance, Advanced call letter and Final Call letter for impacts to Medicare product management.
Knowledge of all operational processes required to effectively administer the Medicare program including Network, claims, encounters, risk adjustment, contact center, sales, IT.
Excellent interpersonal, leadership, motivational, negotiation, influencing, and communication skills; with success in building, developing, and retaining high performing teams.
Able to lead, manage, conclude and recommend using data and experience driven decisions.
Ability to mentor and coach team through ambiguity and able to make decisions to drive towards and accomplish team objectives.
Ability to oversee due diligence and requirement analysis required for roadmap creation, scope and execution for enhancements and/or product cycle or refresh initiatives.
Ability to manage through risk through change control and/or escalation protocols if necessary.

Other:
Required travel up to 25%. Possession of valid California Driver’s License and proof of valid State required auto liability insurance.
We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis.
Job Type: Full-time

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