Medical Mutual of Ohio Manager, Government Programs Operations in Cleveland, Ohio

Manages Medicare daily operations, staff, regulatory reporting and compliance, vendor relationship management, and IT enhancements. Identifies opportunities for improvement, supports Medicare STARS rating and ensures adherence to federal regulations, Centers for Medicare/Medicaid Services (CMS) guidance and internal policies and procedures.

  • Identifies and monitors key performance indicators that assess organization’s ability to meet mandated requirements and performance standards. Analyzes root causes of issues. Tracks and trends issues to identify and implement opportunities for improvement. Oversees CMS regulatory audits and reporting and compliance activities. Coordinates departmental monitoring, auditing and compliance investigations as well as implementation and subsequent monitoring of corrective action plans.

  • Provides day to day supervision of operations and staff to meet performance expectations and regulatory requirements. Manages employee performance while motivating and coaching staff to achieve compliance and positively influence STARS ratings. Promotes professional development. Oversees hiring, training, retention and communication of strategic priorities and organizational goals.

  • Maintains strong subject matter expertise in Medicare Advantage and Part D rules and requirements. Ensures compliance with regulatory requirements and company policies. Monitors changes to regulatory guidance and seasonal software releases to support revisions to department workflows, systems, training, desk procedures and policies. Ensures accurate and timely regulatory reporting and internal management reporting.

  • Supports exceptional customer service to internal and external customers: individual members, employer groups, brokers/agents, internal departments. Investigates and resolves escalated issues and grievances.

  • Oversees IT enhancements / vendor performance against contractual obligations.

  • Bachelor’s degree in Health Informatics, Healthcare or Business Administration, Operations Management, Statistics or related field.

  • 8 years progressive health plan operations (primarily Medicare) experience, 3 years of which are in a leadership capacity.

  • Medicare Advantage enrollment experience preferred.

  • Experience working with IT staff / vendors to support system enhancements and upgrades preferred.

  • Strong working knowledge of Medicare Advantage and Part D regulations and operations.

  • Strong knowledge of Medicare enrollment operations policies, procedures, and systems.

  • Understanding of operational process flow analysis and process improvement methods.

  • Ability to write policies, procedures, forms, templates and other documents that are compliant with Federal laws.

  • Ability to conduct quality improvement initiatives and motivate staff.

  • Intermediate to advanced Microsoft Office skills and knowledge of health insurance operations systems.

  • Strong preference for experience managing a production environment with a high volume of regulatory requirements and work flows with multiple and competing deliverable deadlines.

Job: *5 - Manager

Organization: *Customer Care

Title: Manager, Government Programs Operations

Location: OH-Cleveland

Requisition ID: 1700208