Director, Medicare Operations
Steward Health Care Network (SHCN) takes pride in its community-based care model, which drives value-added tools and services to our communities, patients, physicians, and hospitals across the continuum of care. In addition, Steward Health Care Network promotes care coordination and collaboration within the network in order to provide high-quality, efficient care to patients. With Steward in the community, all residents can be sure that there is a world-class doctor close to where they live.
The network is also responsible for the implementation and execution of our managed care contracts, medical management services, quality improvement programs, data analysis, and information services.
Position Purpose: The Director of Medicare Operations will own daily operational responsibility for Steward's overall Medicare performance and includes responsibility for Accountable Care Organization (ACO) risk contracts with the Centers for Medicare and Medicaid Services (CMS) on a national scale and for ensuring that the budgeted membership, revenue, and earnings is achieved for Medicare Advantage risk contracts. The person in the role will: (1) direct existing initiatives, coordinating with operational teams to strive for continuous improvement in the ways we serve our members, (2) develop and implement future program strategy based on data-driven recommendations responding to novel opportunities and fluctuant CMS policies and (3) coordinate and lead communications with internal and external stakeholder community. Individuals who are passionate to make an impact in the way care is delivered today will resonate the most with our team.
- Leads daily ACO and Medicare Advantage (NGACO and MSSP 1+ and future equivalents) P & L operations in close collaboration with the SVP for Medicare and clinical and performance operation teams applying a mindset of continuous improvement, rigorous evaluation and creative problem-solving.
- Coordinates across all operational teams to activate and engage teams on Medicare risk contract performance on a national scale
- Monitors and evaluates Medicare initiative performance in real-time and proactively seeks out opportunities to further enhance existing efforts - collaborates with analytics team to establish new dashboards and performance monitoring tools for Medicare
- Manages the Medicare program managers and effective onboarding of vendors as well as implementation of technology applications that enable seamless operations
- Engages with regional governance structure to proactively plan for and execute appropriate provider communication plans and market specific strategies to achieve budgeted membership, revenue, and earnings targets
- Leads reporting to governing Boards together with SVP of Medicare, Sr. Manager, Medicare specialists, managed care leadership, and regional operations leadership
- Develops the strategy for the Medicare, directing the deployment of care management, risk performance and quality services, managing the associated expenses to achieve the targeted performance revenue
- In collaboration with operational teams, sets annual and monthly performance targets based on claims and real-time metrics
- Develops recommendations for new opportunities (clinical initiatives, vendor partnerships, other) based on return-on-investment projections and cost-benefit-risk due-diligence evaluations using an investor mindset
- Identifies program risks, and develops and implements appropriate corresponding mitigation strategies
- Leads the future SHCN portfolio of Medicare program participation through rigorous analysis
- Evaluates Medicare ACO programs available to SHCN providers on an annual basis, recommending highest value option
- Drives recommended participation profile in consideration of contract structure and MACRA implications
- Oversees post-acute partner contractual relationships with the goal of improving care redesign in collaboration with Contracting and Care Management teams
- Leads SNF, Home Health, Hospice contract strategy together with other Medicare staff and senior SHCN ELT leadership team
- Designs the operational infrastructure to maintain the highest levels of compliance with all requirements of existing and future Medicare contracts and applicable regulations
Education / Experience / Other Requirements
- MBA, MHA, or others Master's degree preferred
- BA required, analytical fields such as Economics preferred
Years of Experience:
- A minimum of five years’ experience working in a fast-paced environment
- Healthcare delivery (e.g. Hospital) experience preferred
- Medicare ACO program experience preferred
- Medicare Advantage health plan or risk management experience preferred
- Experience leading and mentoring one or more direct reports
- Strong interpersonal skills and ability to interact positively with a wide range of constituents
- Ability to work both independently and within a team environment and a multi-dimensional environment. Creative, flexible, self-motivated, professional must possess sound judgment ability to plan and initiate new activities consistent with achieving service excellence
- Proven excellent written and verbal communication skills. Ability to present information to small and, at times, large audiences
- Strong organizational and project management skills including development of project parameters, goals, and timelines and outcome measurement
- Established passion for working towards improving the health of populations
- Analytic skills to collect information from diverse sources and summarize the information and data in order to solve problems
- Ability to function effectively within an ever-changing environment and to meet deadlines and reprioritize as necessary
- Must be able to maintain confidentiality of information
- Proficiency in Excel, Word, PowerPoint, and Microsoft Project; proven ability to learn new information systems as necessary
This position is subject to the COVID-19 Vaccination Policy for Steward Health Care Workforce. Employees in this position will be required to provide adequate proof of vaccination for COVID-19 by an FDA-approved vaccine prior to starting work. Steward will consider requests for exemptions from this vaccine requirement on the basis of medical condition or sincerely held religious belief in accordance with applicable Federal laws.
Steward Health Care is an Equal Employment Opportunity (EEO) employer. Steward Health Care does not discriminate on the grounds of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity and/or expression or any other non-job-related characteristic.
Steward Health Care Network is taking additional, necessary preparations to ensure patients can receive compassionate care in a safe, carefully managed environment – with confidence and without fear.
Our Safe and Ready program consists of a rigorous [three-point] standard ensuring patient safety, confidence and convenience:
- Any COVID-19 related care takes place in designated areas away from other patients and their families.
- A stringent cleaning policy has been implemented throughout our facilities.
- A strictly controlled visitor and masking policy is required for patient and colleague safety.
You can rest assured that we have made the necessary preparations to provide care in a safe, controlled and professional way.