University of Utah Health Care

  • Director, Medicare Advantage - University of Utah Health Plans

    Requisition Number
    34635
    Reg/Temp
    Regular
    Employment Type
    Full-Time
    Shift
    Day
    Work Schedule
    Weekdays
    Location Name
    University of Utah Health Plans
    Patient Care?
    No
    City
    Murray
    State
    UT
    Department
    UIP ENT 01H MEDICARE ADVANTAGE
    Category
    Insurance / Health Plans
  • Overview

    This is a new position and opportunity with University of Utah Health Plans, and the incoming Director of Medicare Advantage has comprehensive responsibility for the Medicare Advantage (MAPD) product, including: the strategic development and execution (launch), working in a matrix environment with operational departments, and working with the University of Utah integrated delivery system and network providers.

     

    Department Overview: This position reports to the Health Plans Chief Operating Officer. University of Utah Health Plans covers approximately 200,000 members in Utah and the Mountain West Region. The plan offers services in Commercial, Individual Exchange, and Medicaid Markets.

     

    Corporate Overview: University of Utah Healthcare is an integrated academic healthcare system with four hospitals including a level 1 trauma center, twelve community health centers, over 1,600 providers, and a health plan serving over 200,000 members. University Healthcare is nationally ranked and recognized for our academic research, quality standards and overall patient experience. In addition to our clinical delivery system, we have a School of Medicine, School of Dentistry, College of Nursing, College of Pharmacy, and College of Health providing education and training for over 1,250 providers annually. We have over 2 million patient visits annually and research grants exceeding $350 million.

     

    This position is not responsible for providing care to patients.

     

    As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, diversity, integrity, quality and trust that are integral to our mission. EO/AA

    Responsibilities

    Accountability

    • Develop and lead product development initiatives and initial bid process including all activities necessary for health plan application to CMS.
    • Establish oversight committee to proactively direct and monitor the bid process, as well as operational and financial development and ongoing product management.
    • Maintain effective strategic and P&L oversight to protect and grow the customer base.
    • Drive change leadership to best align the organization in a rapidly evolving industry and

    Collaboration

    • Establish and maintain necessary relationships with CMS and other relevant entities for proper filings, attestations, etc. both for start-up as well as maintenance of the product.
    • Develop, implement and maintain strong provider engagement and contracting strategies for high performing networks that drive high quality and affordability

    Communication

    • Communicate detailed value propositions to key stakeholders.

    Technical Development

    • Develops and maintains strategies consistent with evolving national programs, methodologies and technologies.

    Financial Management

    • Influence and/or negotiate product, price and services development to ensure value and competitiveness.

    Quality/EPE

    • Define processes and metrics to be monitored including but not limited to financial performance growth, Star/clinical and service quality effectiveness, provider partnerships, FDR (delegated entities), oversight and auditing, and other product management duties.
    • Establish and maintain a comprehensive compliance program working in collaboration with Compliance Officer.

    Performance/Human Resource Management

    • Responsible for hiring, training, performance goals, evaluations, employee discipline and providing coaching and development of all staff.
    • Responsible for providing staff feedback on performance, including on-time appraisals and coaching.

    Relationships and Engagement

    • Develop strategies in collaboration with other health plan departments to ensure strong brand reputation within our communities to ensure customer retention, improve competitive positioning and attract new beneficiaries.

    Knowledge / Skills / Abilities

    • Ability to perform the KPIs of the position, as outlined above.
    • Demonstrated strong verbal and written communication skills.
    • Ability to develop relationships both externally and across all levels of the organization.
    • Ability to communicate effectively to executive level staff as well as external audiences.
    • Demonstrated ability to think strategically, and anticipate future consequences and trends.
    • Demonstrated strong influencing and negotiation skills.
    • Ability to successfully lead in an ambiguous and changing market.
    • Ability to be creative in problem solving and analytical thinking.

    Qualifications

    Qualifications

    Required

    • Bachelor's degree in Health Care Administration, Business Administration, or related area or equivalent experience
    • Five years of related experience with a minimum of three years spent managing a Medicare Advantage plan.
    • Experience successfully managing a Medicare Advantage start up, stabilization and maintenance.

    Qualifications (Preferred)

    Preferred

    • Master's degree in Health Care Administration, business Administration, or related area.

    Working Conditions and Physical Demands

    Employee must be able to meet the following requirements with or without an accommodation.

    • This is a sedentary position in an office setting that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions.

    Physical Requirements

    Listening, Manual Dexterity, Speaking

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