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Job Summary - Director, Dual Special Needs Plans
Holds a pivotal leadership position responsible for developing and executing effective strategies to achieve sustained success of Priority Health Medicare Special Needs Plans (DSNPs). Works collaboratively to align business needs and manage and oversee operational dependencies of the DSNP. Communicates the vision, multi-year roadmaps, and success metrics.
Accountable for DSNP program compliance across all federal and state regulatory requirements, while developing and delivering against DSNP performance metrics. Develops and manages internal and external partner engagement and works closely with the plan's Long Term Supports Services (LTSS) Director to ensure effective execution of LTSS coverage with various external partners. Collaborates with the Medicare product development and marketing teams to develop and implement competitive, innovative product and marketing strategies to ensure a competitive market position. Essential Functions - Director, Dual Special Needs Plans
- Strategic Planning and Execution: Develops and implements strategies to ensure the sustained success of Medicare Special Needs Plans, including creating multi-year roadmaps and defining success metrics.
* Compliance and Regulatory Oversight: Ensures all plans comply with regulatory requirements and standards, maintaining up-to-date knowledge of relevant laws and guidelines. Maintains a strong understanding of the Dual Special Needs Plan (DSNP) regulatory landscape, past, present and future. - Operational Management: Aligns business objectives and manage operational dependencies, ensuring smooth and efficient plan operations
- Analytics and Reporting: Conducts detailed analytics to monitor plan performance and identify areas for improvement, providing regular reports to stakeholders.
- Internal partner engagement: Collaborates with internal partners including, but not limited to care management, quality, population health, etc., to ensure business objectives are supported; provides leadership to create synergy among the various programs and messages.
- External partner engagement: Collaborates with external partners including, but not limited to Long Term Supports Services (LTSS) partners as well as developing and nurturing relationships with community organizations and state regulators.
- Innovation and thought leadership: Engages with relevant trade organizations and attends conferences to identify new trends in the market or new business opportunities that can increase Priority Health's revenue stream and profitability.
- Product Development Collaboration: Works closely with the Medicare product development team to design and implement competitive, innovative products that enhance market position.
- Marketing and Member Communication Collaboration: Works closely with the Medicare marketing & communications teams to design and implement marketing campaigns and member communication strategies that drive growth, retention and a positive member experience.
- Manages staff including selection, development, and evaluation of employees to ensure the efficient and proactive operation of the department that meets or exceeds performance expectations.
- Develops and manages annual cost center budgets to ensure business objectives are met within allocations.
Qualifications - Director, Dual Special Needs Plans
- Required Bachelor's Degree Business, Marketing, Health Care Administration.
- Preferred Master's Degree MBA, MPA or Public Health.
- 10 years of relevant experience Progressively responsible positions and experiences in the areas of product development, strategic planning, market management and large scale project management. Required
- 5 years of relevant experience Insurance or managed care. Preferred
- Experience in the DSNP and/or Medicare-Medicaid demonstration plan space. Preferred
- Demonstrated success in the development and execution of strategy-driven, integrated health care programs. Preferred
- Experience in the management of multiple health plan product lines with proven track record of successfully maintaining and/or improving health plan performance. Preferred
- Leadership in a successful, lean (i.e., limited resources, budgets and staff members) organization or business unit that utilizes multiple channels. Preferred
- Broad experience in directing and getting work done through others. Proven ability to effectively lead cross-functional teams and build processes to deliver results. Preferred
Physical Demands - Director, Dual Special Needs Plans
- Pallet to Waist (6" from floor) > 5 lbs: Seldom up to 10 lbs
- Waist to Waist > 5 lbs: Seldom up to 10 lbs
- Waist to Chest (below shoulder) > 5 lbs: Seldom up to 10 lbs
- Waist to Overhead > 5 lbs: Seldom up to 10 lbs
- Bilateral Carry > 5 lbs: Seldom up to 10 lbs
- Unilateral Carry > 5 lbs: Seldom up to 10 lbs
- Pushing Force > 5 lbs: Seldom up to 10 lbs
- Pulling Force > 5 lbs: Seldom up to 10 lbs
- Sitting: Frequently
- Standing: Occasionally
- Walking: Occasionally
- Forward Bend - Standing: Seldom
- Forward Bend - Sitting: Occasionally
- Trunk Rotation - Standing: Seldom
- Trunk Rotation - Sitting: Occasionally
- Reach - Above Shoulder: Seldom
- Reach - at Shoulder or Below: Seldom
- Handling: Occasionally
- Forceful Grip > 5 lbs: Seldom
- Forceful Pinch > 2 lbs: Seldom
- Finger/Hand Dexterity: Frequently
Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here. On-demand pay program powered by Payactiv Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more! Optional identity theft protection, home and auto insurance, pet insurance Traditional and Roth retirement options with service contribution and match savings Eligibility for benefits is determined by employment type and status
Primary Location SITE - Priority Health - 1239 E Beltline - Grand Rapids
Department Name PH - Market Operations - Medicaid
Employment Type Full time
Shift Day (United States of America)
Weekly Scheduled Hours 40
Hours of Work 8:00 a.m. to 5:00 p.m.
Days Worked Monday through Friday
Weekend Frequency Variable weekends
CURRENT COREWELL HEALTH TEAM MEMBERS - Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only. Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief. Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category. An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team. You may request assistance in completing the application process by calling 616.486.7447.
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Corewell Health
Jan 10, 2025