Steward Health Care System Director, Medicare Operations in Westwood, Massachusetts
Steward Health Care Network (SHCN) takes pride in its community-based care model, which drives value-added tools and services to our communities, patients, physicians, and hospitals across the continuum of care. In addition, Steward Health Care Network promotes care coordination and collaboration within the network in order to provide high-quality, efficient care to patients. With Steward in the community, all residents can be sure that there is a world-class doctor close to where they live.
The network is also responsible for the implementation and execution of our managed care contracts, medical management services, quality improvement programs, data analysis, and information services.
Position Purpose: The Director of Medicare Operations will own daily operational responsibility for Steward's overall Medicare performance and includes responsibility for Accountable Care Organization (ACO) risk contracts with the Centers for Medicare and Medicaid Services (CMS) on a national scale and for ensuring that the budgeted membership, revenue, and earnings is achieved for Medicare Advantage risk contracts. The person in the role will: (1) direct existing initiatives, coordinating with operational teams to strive for continuous improvement in the ways we serve our members, (2) develop and implement future program strategy based on data-driven recommendations responding to novel opportunities and fluctuant CMS policies and (3) coordinate and lead communications with internal and external stakeholder community. Individuals who are passionate to make an impact in the way care is delivered today will resonate the most with our team.
Leads daily ACO and Medicare Advantage (NGACO and MSSP 1+ and future equivalents) P & L operations in close collaboration with the SVP for Medicare and clinical and performance operation teams applying a mindset of continuous improvement, rigorous evaluation and creative problem-solving.
Coordinates across all operational teams to activate and engage teams on Medicare risk contract performance on a national scale
Monitors and evaluates Medicare initiative performance in real-time and proactively seeks out opportunities to further enhance existing efforts - collaborates with analytics team to establish new dashboards and performance monitoring tools for Medicare
Manages the Medicare program managers and effective onboarding of vendors as well as implementation of technology applications that enable seamless operations
Engages with regional governance structure to proactively plan for and execute appropriate provider communication plans and market specific strategies to achieve budgeted membership, revenue, and earnings targets
Leads reporting to governing Boards together with SVP of Medicare, Sr. Manager, Medicare specialists, managed care leadership, and regional operations leadership
Develops the strategy for the Medicare, directing the deployment of care management, risk performance and quality services, managing the associated expenses to achieve the targeted performance revenue
In collaboration with operational teams, sets annual and monthly performance targets based on claims and real-time metrics
Develops recommendations for new opportunities (clinical initiatives, vendor partnerships, other) based on return-on-investment projections and cost-benefit-risk due-diligence evaluations using an investor mindset
Identifies program risks, and develops and implements appropriate corresponding mitigation strategies
Leads the future SHCN portfolio of Medicare program participation through rigorous analysis
Evaluates Medicare ACO programs available to SHCN providers on an annual basis, recommending highest value option
Drives recommended participation profile in consideration of contract structure and MACRA implications
Oversees post-acute partner contractual relationships with the goal of improving care redesign in collaboration with Contracting and Care Management teams
Leads SNF, Home Health, Hospice contract strategy together with other Medicare staff and senior SHCN ELT leadership team
Designs the operational infrastructure to maintain the highest levels of compliance with all requirements of existing and future Medicare contracts and applicable regulations
Education / Experience / Other Requirements
MBA, MHA, or others Master's degree preferred
BA required, analytical fields such as Economics preferred
Years of Experience:
A minimum of five years’ experience working in a fast-paced environment
Healthcare delivery (e.g. Hospital) experience preferred
Medicare ACO program experience preferred
Medicare Advantage health plan or risk management experience preferred
Experience leading and mentoring one or more direct reports
Strong interpersonal skills and ability to interact positively with a wide range of constituents
Ability to work both independently and within a team environment and a multi-dimensional environment. Creative, flexible, self-motivated, professional must possess sound judgment ability to plan and initiate new activities consistent with achieving service excellence
Proven excellent written and verbal communication skills. Ability to present information to small and, at times, large audiences
Strong organizational and project management skills including development of project parameters, goals, and timelines and outcome measurement
Established passion for working towards improving the health of populations
Analytic skills to collect information from diverse sources and summarize the information and data in order to solve problems
Ability to function effectively within an ever-changing environment and to meet deadlines and reprioritize as necessary
Must be able to maintain confidentiality of information
Proficiency in Excel, Word, PowerPoint, and Microsoft Project; proven ability to learn new information systems as necessary
Steward Health Care is an Equal Employment Opportunity (EEO) employer. Steward Health Care does not discriminate on the grounds of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity and/or expression or any other non-job-related characteristic.