Director of Medicare Services

The Director of Medicare Services will be responsible for overseeing and enhancing the Medicare services offered by apree health. This pivotal role requires a forward-thinking individual with extensive knowledge of Medicare regulations, an ability to strategize, innovate, and execute plans to ensure the delivery of top-tier services to our Medicare-eligible members.

The Director of Medicare Services will be responsible for the subject matter expertise of all of the solution work needed to support a Medicare line of business. This includes contributing to the requirements and scope for new solution development as well as ensuring that our clinical operations are meeting the needs of this line of business.

This person will need to be a collaborative leader in the context of work with multiple stakeholder teams including clinical services, R&D, compliance professional services, client services, sales as well as up and downstream marketing. This person needs to be able to manage executive level communication with ease through regular well-informed status updates that tie the work to outcomes and KPIs. This person will regularly manage feedback loops, both external and internal and use this feedback to drive solution advancements. Feedback loops will also inform internal team education and meetings.

The preferred candidate will be a problem solver who thrives working across healthcare, technology, and data domains. Someone who is able to identify market problems/needs and mobilize a cross-functional team to solve them. The candidate will have experience working in tech-enabled healthcare services, population health management, or a health tech organization and possess strong analytical and communication skills. This person has a broad understanding of major healthcare regulatory initiatives like Meaningful Use and 21st Century Cures Act and how these regulatory mandates impact primary care and care management. This person also has a deep understanding of product lifecycle management including demonstrated experience writing robust functional and technical requirements and partnering with the R&D team through the product development process. The ideal candidate will enjoy problem solving, have a growth mindset, and be able to drive progress independently.

This candidate will have extensive experience with operationalizing the Medicare requirements and translating them to meaningful and compliant care.

Responsibilities

• Strategic Leadership: Develop and execute a comprehensive strategic plan for the Medicare Services department, aligning with company goals and industry best practices.
• Compliance and Regulatory Adherence: Stay updated and ensure full compliance with all Medicare regulations, policies, and guidelines, mitigating any risks associated with non-compliance.
• Product lifecycle management: Lead product initiatives for the person and care team personas. Ensure robust and streamlined product documentation is completed. Continuously monitor product market positioning against established KPIs and OKRs.
• Stakeholder Management: Communicate with a wide-range of internal and external stakeholders throughout the product life cycle
• Product Leadership: Demonstrate leadership and creativity on complex projects and show foresight through translation of significant market needs to product roadmaps that drive outcomes.
• Product Development Collaboration: Partner closely with both on-shore and off-shore development teams, R&D leadership, and data/technology partners to drive end-to-end product development cycles
• Strategic thinking: Demonstrate a creative and strategic mindset with the ability to think outside the box and envision groundbreaking solutions.
  
  

Experience

• 8+ years of progressive experience in healthcare administration, with a focus on Medicare services and a strong understanding of Medicare regulations, Health and Human Services (HHS), Office of Inspector General (OIG), Code of Federal Regulation (CFR)
• Centers for Medicare and Medicaid (CMS) Program audit experience
• Familiarity with Project Management tools and techniques
• Experience with establishing a Clinical Compliance Oversight Program that satisfies the overall Enterprise Compliance Program Effectiveness strategy
• 5+ years Clinical experience preferred
• Familiarity with HEDIS and STAR quality measures, risk stratification, CAHPS, and gap closures required
• Familiarity with National Committee for Quality Assurance (NCQA)
• Familiarity with Contractual negotiation specific to Medicare Compliance
• Medical writing experience preferred
• Bachelor’s degree or master’s in relevant field required, business/economics, leadership, communications, healthcare administration
• Proven leadership and managerial experience, with a track record of successfully leading teams and achieving departmental goals.
• Exceptional knowledge of Medicare policies, procedures, and compliance requirements
• Strong business acumen and intellectual curiosity - ability to approach complex business problems in a logical, structured way and drive rapidly toward innovation
• Excellent communication, leadership and interpersonal skills
• Comfortable with a fast-paced environment and willingness to be flexible and pivot when needed
  
  

Physical Demands:

• Requires being at a desk for extended periods of time
• Manual and finger dexterity and eye-hand coordination
• Requires standing, walking and sitting for extended periods of time
• Occasionally lift and carry items up to 50 pounds
• Requires corrected vision, hearing and speech within normal ranges
  
  

Compensation: $147k-$210k/annual salary & bonus eligible (national average, premium markets may vary)