Director, Special Needs Program (Remote)

<strong>At Emergent Holdings, we&rsquo;re creating an innovative environment where our employees belong authentically, contribute meaningfully, and thrive intentionally &mdash; both personally and professionally.</strong>

Southfield, USA

Emergent Holdings

<p class="p1"><strong>Emergent Holdings is driven by a singular goal &mdash; improving the health and safety of our customers and our communities. How do we do that? We create innovative insurance products, technology solutions, and services to support our key stakeholders &mdash; individuals, employers, providers, and strategic partners &mdash; improving the health and safety of the people and places we serve.</strong></p>

keywords: success,program,sales,program,performance,reporting,teamwork,implementation,research,experience,project management,degree,talent acquisition,critical thinking,leadership


Competitive Compensation and Benefits Package

Overview: <p>The Medicare SNP Program Director will be responsible for leading the development, implementation and ongoing operation of our Medicare Special Needs programs across Senior Health Services service area in a manner consistent with regulatory requirements and Senior Health Services strategies and goals.&nbsp;</p> <p>This key role will be the business owner for these growing programs &ndash; working with and connecting and aligning functional areas, with Medicaid as appropriate and enhancing collaboration to assure success. Responsible for sales and membership growth, marketing and sales team guidance and support including the development of training, community relationships/activation, provider network structure, quality, clinical outcomes and care management delivery, Star ratings, member experience, product design, and financial performance.</p>
Responsibilities: <ul> <li>Manage Identifies, develops, plans and executes short- and long-term strategies, participating with peers and others to ensure effective integration; oversees the development and implementation of organization goals and actions plans.</li> <li>Directs and/or coordinates staff in the implementation of strategic work plans, development and implementation of new benefits, or other initiatives including but not limited to, CMS Five Star Program operational initiatives and Hierarchical Condition Category (HCC) maintenance and improvement activities.</li> <li>Refines and monitors key performance indicators (KPIs) ; intervenes as needed and escalates any issues where performance falls outside of expected levels.</li> <li>Collaborates with other departments, including Clinical Operations, Pharmacy, BI, Finance, Marketing, Quality, Provider Network Operations, Customer Services, Sales, Broker Relations, Enrollment and Information Technology to develop performance metrics and implement strategies that will enhance the Program and services and maximize effectiveness of the various functions and assure performance improvement if actual results fall outside of expected parameters.</li> <li>Supports the annual bid cycle by working with Actuary, Pharmacy, delegated vendors, and other operational stakeholders; oversees all activities related to the Program application, service area expansions and the annual bid process</li> <li>Drives secondary research and qualitative and quantitative analysis to inform design and development.</li> <li>Develops and manages Program budget; implements appropriate interventions.</li> <li>Collaborates with the Managing Director, MA Compliance Oversight, and line management to ensure compliance with CMS regulations. Provide support for preparation and follow up for CMS site visits and audits, as needed.</li> <li>Oversees the development of relevant, timely and accurate internal and external filings, reports and documents.</li> <li>Ensures that all educational, product training and agent certification programs are updated annually and implemented for all appropriate internal and external parties; provides direction on key messaging to assure consistency across the organization.</li> <li>Monitors and collaborates with Marketing on the execution of all brand and direct to consumer advertising, public relations, television, digital outreach, and mail campaigns.</li> <li>Coordinates data mining and data analysis activities for provider contracting and performance oversight and HCC improvement initiatives.</li> <li>Collaborates with staff across the organization to research specific issues as necessary to develop and analyze solutions and make policy or programmatic recommendations to address operational issues.</li> <li>Provides business requirements and oversees system configurations to ensure the system effectiveness in customer service, provider payments, clinical operations, analytics/reports and other activities that rely on information system solutions.</li> <li>Develops and updates Program policies and procedures for review and approval.</li> <li>Promotes and maintains and ensures that direct reports promote and maintain an environment that supports Senior Health Services&rsquo; strategy, vision, mission and values.</li> </ul> <p><em>This position description identifies the responsibilities and tasks typically associated with the performance of the position.&nbsp; Other relevant essential functions may be required.</em></p> <p>&nbsp;</p>
Requirements: <p><strong>DIRECTION EXERCISED:</strong></p> <p>Directly supervises exempt and non-exempt staff in accordance with company policies and applicable Federal and State Laws.&nbsp; Responsibilities include, but are not limited to, effectively interviewing, hiring, terminating, and training employees; planning, assigning, and directing work; appraising performance; rewarding and counseling employees; addressing complaints and resolving problems; supporting and encouraging the engagement process.</p> <p><strong>EMPLOYMENT QUALIFICATIONS:</strong></p> <p><strong>EDUCATION OR EQUIVALENT EXPERIENCE:</strong></p> <p>Bachelor's Degree in Health Policy, Business, or related field required; Master&rsquo;s Degree in related field strongly preferred.</p> <p><strong>EXPERIENCE:</strong></p> <p>Ten (10) years of progressively more responsible experience in Medicare/Medicaid.&nbsp; 5+ years working in a matrix organization. Demonstrated leadership and management experience required, including managing productive and effective teams with competing priorities.&nbsp; Bilingual skills preferred.</p> <p><strong>SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:</strong></p> <ul> <li><a target="_blank">Proven leader with the ability to inspire others, build strong relationships, and contribute to a positive team culture; ability to interface effectively with management at all levels, as well as external contacts or clients</a></li> <li>Advance critical thinking skills demonstrated through problem solving for complex business problems; structured and logical thinker with ability to craft a story line to communicate strategic initiatives to different audiences</li> <li>Excellent analytical skills, financial modeling capabilities, and communication ability using Microsoft Office (Excel, Word, and PowerPoint &ndash; including developing others&rsquo; expertise in these tools)</li> <li>Strong written and verbal communication skills and ability to communicate and build relationships across the organization and at the executive level</li> <li>Comfort with large data sets, data modeling, and interpretation &ndash; proven ability to synthesize complex data and information to support effective decision making (familiarity with CMS and other industry data sources is preferred)</li> <li>Project management experience and proven track record as a formidable team player and collaborator; experience leading and managing teams successfully required</li> <li>Self-driven, highly organized, and consistent attention to detail, with ability to manage multiple time-sensitive priorities simultaneously</li> <li>Ability to handle ambiguity and transition a concept to a defined strategy</li> </ul> <p><strong>WORKING CONDITIONS:</strong></p> <p>Work is performed in an office setting with no unusual hazards.&nbsp; Occasional travel required.</p>