Manager, Medicare Programs

You will report to the Sr. Director, Product and Growth and manages the SFHP Care Plus (a Medicare Dual Special Needs Plan) product development lifecycle, working to gather team member input and deliverables within required timelines. You will ensure the annual Plan Benefit Package (PBP) and bid submissions comply with regulatory requirements and deadlines. Additionally, the Manager, Medicare Programs will support activities to monitor ongoing compliance and high-quality operational performance of staff and the program.

You will be a subject matter expert, support functional teams with annual implementation, readiness for Annual Enrollment Period and product go-live for each plan year. The Manager, Medicare Programs will focus on process improvement, organizational change management, program management and other processes relative to Product and organizational priorities. Also, you will lead building business programs, in collaboration with operational leaders, to meet critical compliance and operational needs.

Please note that while SFHP supports a hybrid work environment, you are required to be onsite and in-office a minimum of 4 days per month. This is a hybrid position, based in our Downtown San Francisco office.

Salary: $113,000 - $133,000 per year

WHAT YOU WILL DO:

• Bring Medicare experience, support SFHP's D-SNP operating model, and lead planning and implementation efforts.
• Support functional decision-making in building a Medicare program by sharing expertise of industry best practices and facilitating tactical workstreams.
• Manage the annual Medicare/D-SNP plan benefit package design and applications process.
• Manage and apply product development lifecycle to the application process, bid development, benefit designs, member materials, and go-to-market strategy.
• Support team members in the identification and planning of short- and long-term strategies to help develop our D-SNP product.
• Be an internal subject matter expert (SME) and ensure readiness of D-SNP operational functions and performance (e.g., Marketing, Sales, Enrollment, Risk Adjustment, STARs).
• In collaboration with our Enterprise Project Management Office, help develop project plans, operational and performance readiness plans, and timelines to support a successful D-SNP product.
• Engage and oversee the work of external vendors.
• Support network adequacy reporting and documentation with Provider Services and other departments to ensure that plan meets all network adequacy standards for the application and on an ongoing basis.
• Collaborate with Member Services to develop and implement an operational strategy for D-SNP Customer Services and Grievances and Appeals functions.
• Develop internal communication documents and Medicare training criteria for SFHP employees and first tier downstream entities.
• Develop documentation to support meeting presentations and the tracking and reporting of the program's performance.
• Support Medicare program development with requirements gathering, business case creation, and improvement plans.
• Contribute to and/or lead detailed data analysis.
• Support functional teams through information exchange, training, and collaboration

WHAT YOU WILL BRING:

• Bachelor's degree in public health, administration, business, or other related areas; or equivalent work experience. Masters degree preferred.
• 5 or more years' experience in product development, process improvement or product management, within a Medicare environment.
• 3 or more years of leadership/people management experience.
• 2 or more years' experience developing operational Medicare components.
• Knowledge of state and federal managed care program requirements, including Medi-Cal and Medicare health care laws.

WHAT WE OFFER:

• Health Benefits
  
  
  
  • Medical: You'll have a choice of medical plans, including options from Kaiser and Blue Shield of California, heavily subsidized by SFHP.
  • Dental: You'll have a choice of a basic dental plan or an enhanced dental plan which includes orthodontic coverage.
  • Vision: Employee vision care coverage is available through Vision Service Plan (VSP).
  
  
  
  
• Retirement - Employer-matched CalPERS Pension and 401(a) plans, 457 Plan.
• Time off - 23 days of Paid Time Off (PTO) and 13 paid holidays.
• Professional development: Opportunities for tuition reimbursement, professional license/membership.

ABOUT SFHP:

Established in 1997, San Francisco Health Plan (SFHP) is an award-winning, managed care health plan whose mission is to provide affordable health care coverage to the underserved low and moderate-income residents in San Francisco County. SFHP is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees and its 175,000+ members have access to a full spectrum of medical services including preventive care, specialty care, hospitalization, prescription drugs, and family planning services.

San Francisco Health Plan is proud to be an equal opportunity employer. We are committed to a work environment that supports, inspires, and respects all individuals and in which our people processes are applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, or other protected characteristics.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

San Francisco Health Plan is an E-Verify participating employer.

Hiring priority will be given to candidates residing in the San Francisco Bay Area and California.

#LI-Hybrid

(Hybrid remote/in-office)

PI278878196