Company Statement

For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continues improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.

Medicare Product Leader

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Director and Equivalent
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190T3 Requisition #
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Monitor the overall performance by Medicare Product to ensure that each product is performing as expected.  Oversee the product performance of individual Medicare products designed to drive membership growth/retention, MER, margin, improve customer satisfaction and quality/outcomes, and enhance operational effectiveness.  Drive the development of requirements and execution of new processes to support operational effectiveness and efficiency for Medicare to meet contribution margin targets.  Recommend plans to implement new/modified benefits and services in conjunction with cross-functional leaders at all levels throughout the enterprise.

Responsibilities:
  • Develop and execute initiatives and work plans with key stakeholders to implement and execute product strategies and programs that drive operational effectiveness, improvement and operational discipline. Which includes developing and implementing a network strategy to improve unit cost, working with Care Management to develop and implement care management strategies to reduce utilization, building Health Care Cost Containment initiatives.
  • Develop and execute initiatives company-wide in conjunction with the Vice President, Medicare to help EmblemHealth reach its annual and long-term goals for Medicare programs.
  • Evaluate financial policies and operational processes, and execute all opportunities to improve Medicare programs’ performance.
  • Recommend and communicate strategies, and use persuasion and influence, to gain support within the organization from senior leadership to align the processes that support Medicare growth and retention.
  • Develop, oversee, assess and evaluate retention strategies and options, and execute strategies to reduce disenrollments. 
  • Work with the Director of Medicare Strategy to implement a social determinants of health strategy.
  • Structure project work plans and develop roadmaps with cross-functional partners to support the execution and implementation of strategic recommendations.
  • Oversee implementation of processes and actions that increase accountability throughout the organization and maximize opportunities for successful project execution.
  • Drive internal/external communications and training plans for Medicare products
  • Serve as EmblemHealth’s SME, interfacing with (external) NYS and (internal) Medicare leads to mentor and develop staff; and to facilitate understanding of Medicare program goals and objectives across the organization.
Qualifications:
  • Bachelor’s Degree required; MBA or equivalent preferred
  • 10+ years of relevant work experience, including positions of increasing scope and responsibility required
  • 5+ years of government programs healthcare experience preferred
  • 2 years of provider network experience preferred
  • 5 years of Medicare operations experience preferred
  • Knowledge of financials preferred
  • Experience in using metrics and analytics to quantify goals and results, and in presenting information in usable form required
  • Excellent communication skills (verbal, written, presentation), including the ability to negotiate and persuade, with all levels and types of audiences, both internally and externally required
  • Industry level knowledge of Medicare rules, regulations, and processes required
  • Demonstrated ability to effectively execute on multiple competing priority items/tasks/projects required
  • Working knowledge of program management required
  • Proficiency in MS Office suite (word processing, database/spreadsheet, presentation, program management) required

EEOC Statement

We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.

Sponsorship Statement

Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.

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