Medicare Program Manager

Location: Orange, CA
Date Posted: 08-01-2018
Medicare Program Manager – Managed Care
Orange, CA
Medicare Program Manager Job Summary: 
  • Assist in the management of the health plan’s daily relationship with the Department of Health Care Services (DHCS) and the Centers for Medicare & Medicaid Services (CMS) for the health plan’s Medicare/Medi-Cal programs.
  • Analyze, interpret and make recommendations regarding the regulatory implications of changes to statutes, regulations, sub-regulatory guidance, and contracts.
  • Support and facilitate the Medicare bid development and submission process for Medicare programs.
  • Lead and facilitate regulatory audits and audit readiness activities.
  • Manage the submission of regulatory filings and reporting requirements on an ongoing basis.
  • Manage the process for the issuance, development, remediation, and validation of corrective action plans (CAPs) for identified and/or reported issues of non-compliance.
  • Work with departments in the development of annual member materials for the Medicare programs (i.e., Evidence of Coverage, Summary of Benefits, and Provider Directories).
  • Assist in the review, development, revision, and maintenance of policies and procedures related to Medicare programs.
  • Assist in the preparation of updates and reports to management, Board of Directors, and Compliance Committee related to regulatory affairs and compliance activities.
  • Work with all departments in response to inquiries, problem-solving, and promoting the mission and message.
  • Assist in the development and implementation of process improvements for the Regulatory Affairs & Compliance (Medicare) department.
  • Keep current on the local, state, and federal regulatory environment to identify issues that may impact the health plan’s programs.
  • Represent the health plan at various internal and external meetings.

Medicare Program Manager Background:   
  • Bachelor’s degree in a health care related field, or equivalent work experience required.  Master’s degree preferred.
  • 3+ years of experience in government or health care in a public or regulatory affairs role.
  • Experience in health care, health plans, Medicare Advantage, Medicare Part D, Special Needs Plans (SNPs), Medicare-Medicaid Plans (MMPs) / Cal MediConnect, and/or a Program of All-Inclusive Care for the Elderly (PACE).
  • Valid driver’s license and vehicle, or other approved means of transportation, an acceptable driving record, and current auto insurance will be required for work away from the primary office 5% of the time or more.
  • Regulatory requirements related to Medicare Advantage, Medicare Part D, Medicare-Medicaid Plans (MMPs) / Cal MediConnect, and Program of All-Inclusive Care for the Elderly (PACE).
  • Microsoft Office applications:  Word, Excel, PowerPoint and Visio.

480.425.2451 (CALL – TEXT – FAX)
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