Company Statement

EmblemHealth is one of the nation’s largest not for profit health insurers, serving members across New York’s diverse communities with a full range of commercial and government-sponsored health plans for employers, individuals, and families. With a commitment to value-based care, EmblemHealth partners with top hospitals and doctors, including its own AdvantageCare Physicians, to deliver quality, affordable, convenient care. At over a dozen EmblemHealth Neighborhood Care locations, members and non-members alike have access to community-based health and wellness guidance and resources. For more information, visit emblemhealth.com.

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Medicare Perf. Mgmt. & Transformation Dir.

🔍 New York, New York

New

💼: EmblemHealth

📅   : Jun 23, 2026 Post Date

Summary of Position

Lead Medicare performance management by connecting strategy and execution; and integrating data, insights, and execution across financial, operational, quality, and growth dimensions.
Translate complex analytics into clear priorities, executive-ready insights, and actionable recommendations to support strategic and operational decision-making.
Serve as a key partner in the development and execution of Medicare strategy - shaping priorities, investments, and longterm direction.
Drive performance improvement and remediation through structured governance, performance reporting (KPIs, dashboards), and disciplined execution across functional teams.
Ensure the Medicare business is financially sound, operationally reliable, compliant and market competitive.

Principal Accountabilities

Lead Medicare Performance Management & Reporting: define, monitor and evolve Key Performance Indicators (KPIs) and develop enterprise dashboards and scorecards aligned to Medicare segment goals and establish transparent reporting to communicate goals and execution across the organization.
Drive Performance Improvement & Remediation: conduct gap analyses; identify root causes; partner with functional teams to design, prioritize, and track remediation initiatives with measurable outcomes.
Develop Executive Insights & Presentations: translate complex analyses into clear, concise executive-level presentations, including risks, opportunities and recommendations.
Lead Cross-Functional Execution & Governance; chair performance governance forums; align stakeholders; establish priorities; develop project plans and ensure milestone tracking, accountability and delivery of results.
Provide Strategic Execution Support Across Priority Gaps: flex into high-priority areas requiring additional leadership or analytical support; rapidly assess issues and drive execution to address performance or capability gaps.
Build Strategic & Prioritization Frameworks: support strategy development through strategic assessments, prioritization frameworks, and structured evaluation of initiatives and investments.
Support Sales, Product & Competitive Performance Analysis: evaluate sales channel performance, enrollment forecasting, product competitiveness, and market positioning to inform growth and product strategy.

Qualifications

Education, Training, Licenses, Certifications

Bachelor’s degree in business, Finance, HealthCare Administration, or related field; master’s (MBA) preferred.
Project Management certification (PMI) preferred.

Relevant Work Experience, Knowledge, Skills, and Abilities

10 – 12+ years of progressive experience in healthcare, with increasing scope and responsibility.
5+ years of Medicare experience (products, regulations, economics, competitors).
4+ years in management consulting or equivalent structured problem-solving environment.
Deep understanding of Medicare P&L and key performance drivers.
Experience across Medicare product types (MA, SNP, EGWP, PDP, Med Supp).
Proven ability to develop and effectively utilize tables, dashboards, and performance scorecards.
Experience conducting gap analysis, performance diagnostics, and strategic assessments.
Experience developing prioritization frameworks and business cases.
Strong financial acumen including P&L tracking and enrollment forecasting.
Experience leveraging internal and external data sources (e.g., CMS data, trend reports, primary and secondary research) to drive actionable insights.
Ability to translate complex data into clear, decision-ready insights for executive audiences.
Proven ability to lead complex, cross-functional initiatives with project plans and milestone tracking.
Strong communication and storytelling skills; ability to influence at all levels.
Ability to operate effectively in a matrixed organization without direct authority.
Experience managing people, processes, or project teams.
Advanced proficiency in Excel.
Experience with Access, SQL, or similar data tools.
Expertise in PowerPoint and executive-level presentation development.
Enthusiasm for engaging with AI solutions (e.g., Co-Pilot) to enhance and expedite all deliverables.

Security Disclosure

If you receive a job offer from EmblemHealth, the email will be from “HRTalentAcquisition” with the subject: “Offer of Employment for (job title) – Please respond online.” We will never ask you to join a Google Hangout, buy your own equipment, or pay to apply. We also do not use third-party email services like Yahoo or Gmail.

Pay Disclosure

At EmblemHealth, we prioritize transparency in our compensation practices. We provide a good faith estimate of the salary range for potential hires, which is based on key factors such as role responsibilities, candidate experience, education and training, internal equity, and market conditions. Please be aware that this estimate doesn’t account for geographic differences related to your work location. Typically, new hires may not start at the top of this range, as compensation is tailored to each individual's circumstances. For union positions, salaries will be determined according to the collective bargaining agreement. Join us at EmblemHealth, where your contributions are valued and supported by fair compensation.

EEOC Statement

We value the diverse backgrounds, perspectives, and experiences of our workforce. As an equal opportunity employer, we consider all qualified applicants for employment regardless of race, color, religion, sex, sexual orientation, age, creed, citizenship status, gender identity, pregnancy, marital status, national origin, disability, veteran status, or any other protected characteristic protected by law.

Sponsorship Statement

At EmblemHealth, we are committed to building a diverse and talented workforce. However, we are unable to consider applicants who require, or are likely to require, either before or after hire, visa sponsorship for work authorization in the United States, including but not limited to H-1B, F-1 (STEM OPT), TN, or any other non-immigrant status. Some extremely rare exceptions may apply based on critical business needs.