This position works with multiple cross-organizational teams through the product development process within government programs lines of business, including Medicare Advantage HMO and Special Needs Plans. Key areas of focus include management of market research, competitive analysis, strategic product positioning, and benefit design and pricing. This position is also responsible for coordination and execution of the Medicare product development process from concept through implementation, and ensuring the process is in compliance with State and Federal regulations. Responsible for supplemental benefit vendor relations and operational management.

Functions & Job Responsibilities

• Lead Medicare product strategy, product development and multi-year product roadmap for all Medicare products to achieve product and line of business goals, and effectively promote senior products and services.
• Ensures bids are accurately filed, data and source files for the organization are clean and consistent.
• Lead and supervise product development, including the market research, competitive analysis, product and compliance requirements, review of materials for accuracy and consistency, and the data and research to support decisions in collaboration with Sales, Compliance, Marketing and Provider Network.
• Responsible for implementation of new capabilities and services offered through incremental supplemental benefits
• Ensure business requirements are accurately identified in alignment with current product framework and capabilities; including the identification of new product opportunities
• Develop benefit reports for key stakeholders such as IPAs
• Lead and facilitate cross-functional teams to meet overall stakeholder expectations and plan's objectives. Responsible for planning and scheduling project goals, milestones, deliverables, and reporting progress as well as risks to management stakeholders.
• Develop and maintain subject matter expertise related to Medicare Advantage service area expansions, notice of intent to apply, bid and implementation planning.
• Provide consultation to all internal areas with regard to product designs, and internal and vendor partner capabilities.
• Prepare and deliver presentations to management, members, brokers and external audiences to solicit support in the development, implementation or continued monitoring of products
• Provide leadership and guidance in analyzing sales areas and opportunities in collaboration with the Sales, Actuarial, Underwriting, Analytics, Provider Network, and Compliance teams in the design and analysis of plan designs and networks, relying on industry research, historical product performance and market trends.
• Responsible for supplemental benefit vendor relations and operational management.

#LI-Remote

Leadership Expectations

By way of leadership approach, mobilize others to create extraordinary results, and unite people to turn challenges into successes by championing the following:

1. Model the Way:

• Clarify values by finding your voice and affirming shared values
• Set the example by aligning actions with shared values

2. Inspire a Shared Vision

• Envision the future by imagining exciting and ennobling possibilities
• Enlist others in a common vision by appealing to shared aspirations

3. Challenge the Process

• Search for opportunities by seizing the initiative and looking outward for innovative ways to improve
• Experiment and take risks by consistently generating small wins and learning from experience

4. Enable Others to Act

• Foster collaboration by building trust and facilitating relationships
• Strengthen others by increasing self-determination and developing competence

5. Encourage the Heart

• Recognize contributions by showing appreciation for individual excellence
• Celebrate the values and victories by creating a spirit of community

Required Qualifications

Education & Experience:

• 10+ years of experience working with Medicare programs, preferably within a Health Plan setting
• Minimum of 7 years of experience in Medicare product development
• Minimum of 5 years of experience leading a team is required

Skills:

• Advanced knowledge of Medicare within the health insurance industry
• Knowledge of Federal & relevant State legislative & regulatory requirements
• Knowledge of health payer operations and customer operations

Physical & Working Environment

Physical requirements needed to perform the essential functions of the job, with or without reasonable accommodation:

• Must be able to travel when needed or required
• Ability to operate a keyboard, mouse, phone and perform repetitive motion (keyboard); writing (note-taking)
• Ability to sit for long periods; stand, sit, reach, bend, lift up to fifteen (15) lbs.

Ability to express or exchange ideas to impart information to the public and to convey detailed instructions to staff accurately and quickly.

Work is performed in an office environment and/or remotely. The job involves frequent contact with staff and public. May occasionally be required to work irregular hours based on the needs of the business.

Clever Care Health Plan is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.

Salary ranges posted on the job posting are based on California wages. Salary may be higher or lower depending on the candidate’s state residency.