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Medicare/Medicaid Program Director
Position Summary
The Medicare/Medicaid Program Director reports to the Sr. VP of Operations to effectively manage CCA’s Senior Care Options and OneCare programs. He/she is responsible for managing effective short and long term planning to ensure progressive and effective operations within Medicare/Medicaid Products.  He/she will develop and drive the organization’s efforts at program sustainability, the quality of services provided by CCA, and ensure financial viability and ongoing compliance with State and Federal contract requirements.
The position acts as the key leader in driving CCA project plans to achieve collaboration internally that will enable the organization to deliver on program goals, clinical integrity and compliance goals. He/she will coordinate a broad range of activities to ensure inter-departmental programmatic changes are proactively orchestrated to maximize the effectiveness of resources, ensure transparency with communications regarding program changes and ensure compliance with key deliverables on time, and within budget. This individual will develop and lead efforts to set program goals and targets with regulators, and drive the agenda forward through state and federal collaboration, program management, and aggressively pursuing success through effective program management.
Key Responsibilities
  • Develop and maintain the SCO and OneCare Products line and take a leadership role in interpreting contract documents and working closely with all departments to assure efficient operation of the plan in compliance with state, federal and other regulatory bodies.
  • Lead the design and deployment of SCO and OneCare benefits in collaboration with clinical and marketing leadership.
  • Working collaboratively with Compliance to ensure CCA complies with regulatory requirements for the operations of the Medicare/Medicaid products as defined by CMS, EOHHS, and other applicable State and Federal laws.
  • Organize the review of changes to regulations governing Medicare/Medicaid programs and provide comments as appropriate, and support efforts to implement such changes.
  • Establish and develop positive relationships between CCA and CMS/EOHHS regulatory teams.
  • With CCA leadership, participates in discussions with CMS, EOHHS and other regulatory agencies to promote the long term goals of CCA.
  • Collaborate with the senior management team to develop a strategic and tactical plan to achieve the desired annual goals and targets.
  • Collaboratively develop with all levels of the organization key strategic presentations for delivery to state, federal and internal audiences.
  • Manage and prioritize all opportunities to enhance regulator relationships and accelerate the decision making process that will support program growth.
  • Develop and implement program plans to manage CMS/EOHHS required changes that impact Plan operations, including EOHHS or CMS enrollment efforts, marketing campaigns, etc.
  • Develops, initiates, and maintains policies and procedures for the general oversight of SCO and OneCare product lifecycle, including PBP submissions, benefit review cycle, NOIA submissions, etc.
  • Serves as the primary contact with CCA management staff to plan for program expansions and staffing needs across impacted departments.
  • Manages relationships with CMS and EOHHS staff, strive to identify key opportunities to promote CCA’s value to regulators, and drives discussions to satisfy plan objectives.
  • Leads efforts to develop project plans that include action plans to satisfy key CMS application requirements, network adequacy, etc.
  • Works closely with Vendor Oversight leadership to ensure all delegated functions are aligned with CCA initiatives to grow and/or enhance the overall member experience.
  • Attends seminars, conferences, or performs research to proactively identify national innovations in SCO, OneCare, other “duals” programs, or other senior based products that could be modified or leveraged for use by CCA.
  • Partner with the VP of Regulatory Affairs and Compliance to serve as the primary contact with staff at CMS, EOHHS, and other relevant organizations.
  • Support organizational training initiatives as required.
Minimum Qualifications
  • Bachelor's Degree or equivalent experience.
  • Preferred Educational Experience, Master's Degree.
  • Minimum Years’ Experience Required 7-10 years.
  • 7+ years of experience related to Medicare/Medicaid programs.
  • 7+ years directly engaged in relationship management across the healthcare market, including regulators, consumers, providers and advocacy groups.
  • Prior experience implementing significant programmatic changes, product changes, or regional expansions.
  • Possesses strong planning skills to keep the organization focused on a set of strategic objectives
  • Demonstrated ability to manage multiple priorities simultaneously in a deadline driven environment with accurate resource and time estimates
  • Excellent customer service skills with effective communication skills both written and verbal.
  • Excellent interpersonal skills, including the ability to work across the organization and to interact, influence and negotiate effectively at all levels of management.
  • Experience working with state and federal regulators and an excellent understanding of the regulatory environment.
  • Knowledge and experience with CMS Innovation strategies and service delivery models.
  • Knowledge of best practices in Medicaid nationally.
  • Comfortable dealing with and managing in an extremely fluid, fast-paced environment.
  • Effectively communicates optimism and confidence in the future direction of the company.
  • Must be a self-starter and able to work with minimum supervision.
  • Decision making/problem solving skills.
  • Record of success in driving initiatives and inspiring teams to achieve process improvement.
  • Effective in relationship building in a matrix environment and negotiating solutions a broad range of disciplines.
  • Exceptional oral and written and presentation skills.
 Please note employment with CCA is contingent upon acceptable professional references, a background check (including Mass CORI, employment, education, criminal check, and driving record, (if applicable)), an OIG Report and verification of a valid MA/ RN license (if applicable).
Commonwealth Care Alliance is an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws.
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