GENERAL SUMMARY
Responsible for the implementation of Medicare Part D and Medicare Advantage programs. Provides guidance and consultation for new product start-up, program design, and regulatory compliance. Leads Medicare Part D and Medicare Advantage operational interface and ensures strategic and tactical business
goals are achieved.
ESSENTIAL RESPONSIBILITIES
- Guides, consults, and leads product implementation and strategic focus for Medicare Part D and Medicare Advantage.
- Directs operational functions of Medicare products including but not limited to; network operations, member services, and claims operations.
- Responsible for Medicare product design features, integration schedule, and operational readiness in a new product start-up environment.
- Maintains an awareness of trends, developments, and governmental regulations in Medicare and managed health care organizations.
- Coordinates strategies and recommends policy positions with senior management regarding legislative issues and regulatory concerns.
- Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions, including, employment, termination, performance reviews, salary reviews, and disciplinary actions.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
- Bachelor's degree or equivalent experience. Master's degree preferred.
- Significant (7-10 years) experience in Medicare Operations, Medicare legislative issues, and/or Medicare compliance functions.
- Previous (3-5 years) management experience required.
- Familiarity with regulations and statutes impacting the managed care environment.
- Ability to perform analysis and legal research to identify and clarify issues.
- Excellent consulting and leadership skills.
- Excellent interpersonal skills and effective communication and presentation skills.
- Able to effectively coordinate multiple projects.
- Proficient with PC applications.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Executive/Senior Level Officials and Managers
Primary Location: King of Prussia, PA, US
Organization: 37910 - Medicare Part D Overhead
Schedule: Full-time
Job Posting: 2013-02-06 00:00:00.0
Job ID: 1310486