Director of Medicare Services

2 days ago

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apree health

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Description

• Overseeing and enhancing Medicare services offered by apree health. • Develop and execute a comprehensive strategic plan for the Medicare Services department, aligning with company goals and industry best practices. • Stay updated and ensure full compliance with all Medicare regulations, policies, and guidelines, mitigating any risks associated with non-compliance. • Lead product initiatives for the person and care team personas, ensuring robust and streamlined product documentation. • Communicate with a wide-range of internal and external stakeholders throughout the product life cycle. • Demonstrate leadership and creativity on complex projects and translate significant market needs to product roadmaps that drive outcomes. • Partner closely with both on-shore and off-shore development teams, R&D leadership, and data/technology partners to drive end-to-end product development cycles. • Demonstrate a creative and strategic mindset with the ability to think outside the box and envision groundbreaking solutions.

Requirements

• 8+ years of progressive experience in healthcare administration, with a focus on Medicare services and a strong understanding of Medicare regulations, Health and Human Services (HHS), Office of Inspector General (OIG), Code of Federal Regulation (CFR) • Centers for Medicare and Medicaid (CMS) Program audit experience • Familiarity with Project Management tools and techniques • Experience with establishing a Clinical Compliance Oversight Program that satisfies the overall Enterprise Compliance Program Effectiveness strategy • 5+ years Clinical experience preferred • Familiarity with HEDIS and STAR quality measures, risk stratification, CAHPS, and gap closures required • Familiarity with National Committee for Quality Assurance (NCQA) • Familiarity with Contractual negotiation specific to Medicare Compliance • Medical writing experience preferred • Bachelor’s degree or master’s in relevant field required, business/economics, leadership, communications, healthcare administration • Proven leadership and managerial experience, with a track record of successfully leading teams and achieving departmental goals. • Exceptional knowledge of Medicare policies, procedures, and compliance requirements • Strong business acumen and intellectual curiosity - ability to approach complex business problems in a logical, structured way and drive rapidly toward innovation • Excellent communication, leadership and interpersonal skills • Comfortable with a fast-paced environment and willingness to be flexible and pivot when needed