MVP Health Care Director, Medicare Operations in Rochester, New York

The Director of Medicare Operations is responsible for driving key elements of the overall Medicare strategy that contribute to realizing membership, financial, quality and service performance targets. This position works collaboratively with all functional areas within the organization to ensure that Medicare operational requirements are met and that optimal business processes are implemented and maintained. This position provides day-to-day leadership, direction and support to the functional areas that service the Medicare business line and ensures alignment with the overall organizational goals. Directs and implements enterprise-wide Medicare product changes and programs, ensuring all programmatic, legal, administrative, quality and operational requirements are clearly identified and met and proper systems are in place to optimize business performance and ensure changes are aligned with the overall organizational goals. Directs operational compliance with requirements of the Centers for Medicare & Medicaid Services (CMS) for the Medicare line of business as the Operational Compliance Leader. Works collaboratively to direct and ensure that functional areas are fully informed and trained on all Medicare programmatic and operational requirements and ensure that formal, written policies and procedures are developed and implemented for each operational area that supports the Medicare product line. Builds and maintains collaborative partnerships within the organization to assure the success of Medicare business strategies. Leads or serves on numerous cross-functional workgroups involving key managers and senior managers to address new requirements or issues impacting Medicare performance. In conjunction with senior leadership, drives key elements of the Medicare strategic plan to ensure that the organization’s business goals and objectives are achieved. Provides direction and support to functional areas that service the Medicare line of business. Ensure that performance targets are set and clearly communicated to the appropriate business units. Leads teams and works with individuals in departments throughout the organization to drive improvement in provider engagement, clinical care, data integrity, customer satisfaction, communication with members and providers. Directs and manages direct staff in day to day duties per their job descriptions. Manage department finances within budget. Develops and implements improvement projects identified through internal analyses or as required by CMS. Ability to maintain confidentiality and adhere to regulatory compliance issues as they exist and change from time to time. Performs other related duties as assigned.


Minimum Education:
Bachelor’s degree in business or healthcare related field required.
Master’s degree in healthcare or business preferred.

Minimum Experience:
Extensive experience (8+ years) in healthcare management, especially in areas related to Medicare functions required.
Knowledge/understanding of product development, health insurance operations required.
Knowledge/understanding of “leading practices” in Medicare managed care.
Knowledge of Medicare reimbursement, regulations and requirements required.

Required Skills:
• Ability to work collaboratively with staff at all levels in the organization.
• Excellent analytical skills with strong project management skills.
• Effective skills in the following: communication, facilitation, presentation, and interpersonal skills.
• Proven leadership in project planning, management and execution; motivated with superior organizational, problem solving and decision making skills.
• Orientation toward goal-setting and performance management to achieve bottom-line results.