Director, Medicaid & SNP Products

This position is responsible for Medicaid and Duals product portfolio development and management. The Director will design, implement, maintain, document and analyze current Medicaid and Dual plans, as well as identify, prioritize and develop new markets for product expansion to continuously improve Medica's market position.

This role will work closely with segment leadership, public policy/government relations, finance, compliance, actuarial, sales, operations, tech, marketing, and physician & health services to develop and communicate product intent and ensure accurate and complete understanding and administration both internally and in the marketplace.

Incumbent must have a proven track record with Medicaid and Duals products and understand the operational and financial implications of plan designs in parallel with state contract and federal requirements. Director is subject matter expert on Medicaid and Duals plan performance including membership, income, and operating margin. Position will also implement and manage strategic partnerships and external vendors.

Key Accountabilities:

Product Leadership and Strategy

• Lead Medicaid and Duals strategy and project teams in the initiation, planning, development and successful delivery of product solutions
• Understand and continuously analyze elements of Medicaid and Duals program to identify opportunities for improvements and growth including benefits, networks & provider partners, PBM & formularies, and service areas
• Lead CMS bid development and submission process. Ensure final benefit designs and rates address market trends and member needs and financial goals, as well as understanding downstream implications.

New Business Development

• Lead business case criteria development for market assessment for identified markets, analyze competitive offerings, and identify potential provider partners
• Quantify market opportunities by county through financial modeling and collaboration with segment finance and actuarial
• Support RFP responses through collaboration with other Medicaid and Duals team members along with functional areas to ensure timely, thorough, and robust Medica response to any state bids or procurements
• Drive the identification of risks and ensure mitigation strategies are defined taking a lead on resolution and subsequent process improvements

Building Relationships

• Drive product intent and act as SME on assigned products across the enterprise, including interpretation of state and federal guidance
• Collaborate with segment leadership, public policy/government relations, finance, compliance, actuarial, sales, operations, tech, marketing, physician & health services, and customer service staff to identify, document and resolve product related challenges and opportunities for improvements
• Maintain relationships across Medica segments and identify opportunities for collaboration with an emphasis on growing and supporting Markets strategic initiatives
• Communicate effectively with executive level management and external regulators with an executive summary approach
• Collaborate on multi-year business and program roadmap activities

Managing and Leading Staff

• Manages and coaches direct reports, including developing appropriate annual goals that align with segment strategic initiatives
• Exceptional delegation skills with team leadership to ensure high degree of team accountability

Required Qualifications:

• Bachelor's degree or equivalent experience in related field.
• 10 years of related work experience in a healthcare setting, with minimum 5 years of leadership experience.

Skills and Abilities:

• Medicare Product (Duals at a minimum) including plan benefit design, bid development and operational implementation
• Health plan market identification and development
• Product lifecycle monitoring & establishing metrics to measure product success
• CMS compliance and health plan regulatory environment understanding
• Understanding of state Medicaid
• Health plan operations understanding
• Analytical ability in business planning and financial management
• Demonstrated leadership and influencing skills with the ability to lead and drive change
• Strong communication and presentation skills
• Strong strategic planning skills
• Financial performance measurement skills, accountable for results
• Ability to articulate vision and strategy
• Passionate about member experience and recognized as a positive change agent who can work effectively in creating direction and influence to drive results
• Team player with strong relationship building skills at all levels of the organization and externally
• Creative problem-solving skills using innovative approaches
• Ability to handle multiple complex projects with a high degree of engagement
• Strong drive for results and accountability
• Expertise in project development and implementation management

This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka, MN.

The full salary range for this position is $127,800 - $219,000. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to base compensation, this position may be eligible for incentive plan compensation in addition to base salary. Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.