Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy.AZ Blue offersa variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

The remote work opportunity requires residency and work to be performed within the State of Arizona.

PURPOSE OF THE JOB

This position directs operational activities for the Medicaid Business Segment Medicare products across all markets. This position is a subject matter expert, responsible for leading, operationalizing and supporting all aspects of the Health Plan's Medicare line of business and any Medicare expansion efforts. This in conjunction with Health Plan Senior Leadership.

QUALIFICATIONS

REQUIRED QUALIFICATIONS

1. Required Work Experience

* Four (4) or more years managing Medicare operation program activities, including but not limited to auditing and monitoring as well as reporting to leadership, account management with CMS, etc.

2. Required Education

* Bachelor's degree in Business Administration, Health Care Administration, Public Health Administration or a similar field of study

3. Required Licenses

* N/A

4. Required Certifications

* N/A

PREFERRED QUALIFICATIONS

1. Preferred Work Experience

* N/A

2. Preferred Education

* N/A

3. Preferred Licenses

* N/A

4. Preferred Certifications

* N/A

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

* This position is a subject matter expert, responsible for leading, operationalizing and supporting all aspects of the Health Plan's Medicare line of business and any Medicare expansion efforts. This in conjunction with Health Plan

Senior Leadership.

* Will develop a strategic plan including operational structure and staffing to ensure compliance with all Centers for Medicare and Medicaid (CMS) and state Medicare annual regulatory requirements related to Medicare Operations.

* Ensures the timely submission of all bid and implementation materials to HPMS.

* Ensure the successful completion of the peer review process, prior to any documents or materials uploaded/submitted to CMS and state regulators.

* Will administer all aspects of the Medicare bid process though implementation.

* Will demonstrate experience providing updates, recommendations and offering solutions to senior leadership, compliance committee, and the Board of Directors.

* Serves as a first point of contact for all Medicare regulatory matters related to business operations.

* Works in collaboration with leadership to ensure consistency across all Medicare activities

* Maintains highly effective working relationships with delegated vendors and internal business stakeholders (SMEs) to ensure performance metrics are met and identifies opportunities for improvement

* Provides operational performance updates to management and senior level professional staff and is accountable for Medicaid Business Segment Performance and results

* Other duties as assigned.

COMPETENCIES

REQUIRED COMPETENCIES

1. Required Job Skills

* Knowledge of Medicare rules, regulations, and health care operations.

* Experience and understanding of the Medicare D-SNP program, bid development and implementation process.

* Experience with actuarial teams for bid development.

* Experience interpreting CMS guidance memos, regulations, MCMG and communicating interpretations to internal stakeholders and external stakeholders, as needed.

2. Required Professional Competencies

* Experience managing multiple projects/tasks, providing continuous communication with senior leadership and internal stakeholders to ensure internal and external deliverables meet regulatory timelines.

3. Required Leadership Experience and Competencies

* Proven professional experience building consensus, communicating clear directions among staff and business owners.

* Proven history of successful results in managing issues and driving strategic program initiatives.

PREFERRED COMPETENCIES

1. Preferred Job Skills

* N/A

2. Preferred Professional Competencies

* N/A

3. Preferred Leadership Experience and Competencies

* N/A

Our Commitment

AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.

Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.