Manager, Medicare Programs

Posted: 04/12/2023

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Primary Purpose:

The Manager, Medicare Programs has organization level responsibilities for the administration of all provisions/requirements of HMSA's Medicare contracts/programs. Including but not limited to (Medicare Advantage, DSNP, and Part D) with the Centers for Medicare & Medicaid Services (CMS).

Actively leading and directing the resources within the department to achieve program/contract goals and requirements. Will function as the operational business owner for the above and will represent Medicare Programs in meetings, presentations, reports, and audits with CMS and any other applicable regulatory, investigative, or government agencies.

Minimum Requirements:
  1. Bachelor's degree (B.A.) and 5 years of related work experience, or an equivalent combination of education and experience.
  2. 2 years of management/supervisory or leadership experience.
  3. Effective verbal and written communication skills.
  4. Experience leading diverse teams to meet organizational goals in matrix organizations.
  5. Skilled in driving change and innovative thinking.
  6. Basic knowledge of Microsoft Office applications. Including but not limited to Word, Excel, Outlook, and PowerPoint.
Duties and Responsibilities:
  1. Leadership
    • Identify, initiate, and manage organization-wide projects to ensure that all HMSA's Medicare Program contractual obligations are met or exceeded.
    • Manages necessary changes to existing systems, operations or workflows to address new/revised requirements of CMS/DHS/MQD.
    • Structures work plans and project scope to deliver business impact on high priority issues.
    • Addresses any identified deficiencies in current program quality and administration.
    • Directs regular organization-wide training to develop staff in other key departments as subject matter experts on Medicare Programs.
    • Meet as needed with the Vice President and Director to review progress, report key results and program performance measures and to reestablish priorities.
    • Conducts regulatory analyses and facilitates requirement development, and implementation tracking.
    • Contributes to the development of business strategies for the Medicare line of business.
  2. Effective management of staff
    • Oversees and manages workflows to ensure that services and requests are handled consistently, effectively, and efficiently in order to minimize risks to members and the organization. Documents workflows and work processes.
    • Responsible for ensuring that Medicare Programs contract is meeting requirements established by CMS.
    • Performs various employee management functions including but not limited to; talent management, development, performance reviews, and handles any related adjustments to salary or job description.
    • Prepares and analyses reports summarizing operational and financial performance of the team/programs.
  3. Coordination with external agencies
    • Function as the management liaison between HMSA and Federal/State government representatives for CMS.
    • Responsible for the development and tracking of all written and verbal communication between the Federal and/or State organizations.
    • Acts as a liaison for Medicare programs with external entities.
  4. Other Duties/Functions: 
    • Performs all other miscellaneous responsibilities and duties as assigned or directed.

Equal Opportunity Employer – Minorities/Women/Protected Veterans/Disabled


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