Medicare Director

Santa Barbara, CA, United States

Job Details

Job Location :    Main Office - Santa Barbara, CA

Position Type :    Full Time

Education Level :    Bachelor's Degree

Salary Range :    Undisclosed

Job Category :    Strategic Investment

Description Salary Range:  $164,689 - $247,034

Job Summary

The CenCal Health Medicare Director will serve as a key leader in the development and administration of the Medicare Advantage D-SNP that CenCal Health will launch in 2026.

The Medicare Director will provide cross-functional coordination and execution of activities related to the Medicare Advantage D-SNP product and will work collaboratively with responsible staff and leadership across CenCal Health to support the alignment of operational work within the D-SNP program structure. Prior to implementation, the Medicare Director will serve as a day-to-day liaison with CenCal Health’s D-SNP implementation consultants and will work cross-functionally to support execution of the D-SNP implementation roadmap. Before and after D-SNP implementation, the Medicare Director will provide subject matter expertise and guidance relative to Medicare processes and requirements, partnering with the COO to work collaboratively with the Senior Leadership Team to support D-SNP operations.

The Medicare Director will report to the Chief Operations Officer within the Operations Division and will be a member of the CenCal Health Strategic Leadership Team.

Duties and Responsibilities

In partnership with the COO and CenCal Health’s D-SNP implementation consultants and in advance of 2026, the Medicare Director will:

Serve as a key leader for CenCal Health’s Medicare Advantage D-SNP implementation, working closely with the Chief Operations Officer and the Senior Leadership Team to prepare for the 2026 D-SNP launch though execution of the D-SNP Roadmap.

Partner with D-SNP Program Managers to serve as a day-to-day liaison with CenCal Health’s D-SNP implementation consultants, supporting ongoing activities and escalating roadblocks or concerns.

Function as a core member of the D-SNP Steering Committee and D-SNP Program Alignment Committee, leading and/or contributing to one or more tactics required for D-SNP implementation.

Hold responsibility for supporting the drafting and submission of a complete and high-quality D-SNP application and bid to CMS.

Collaborate with the Senior Leadership Team and staff to support short- and long-term goals/priorities for the Medicare D-SNP, including but not limited to advancing all tactics necessary for D-SNP go-live and integrating tactics through existing committees.

Provide guidance on Medicare policy, fiscal, and compliance matters.

Draft and prepare reports for relevant internal and external meetings and in support of the Chief Operations Officer.

Represent CenCal Health in collaborative Medicare work through the Local Health Plans of California and other associations, as needed.

In support of ongoing D-SNP program management, the Medicare Director will provide subject matter expertise and guidance relative to Medicare processes and requirements, including:

Oversee Medicare enrollment functions related to fulfilling CMS and the Department of Health Care Services requirements, either directly or through vendor oversight.

Collaborate with leadership to support the continued improvement and refinement of core Medicare processes, including but not limited to marketing, quality, network development, and regulatory deliverables.

Contribute to the evolution of the CenCal Health D-SNP Product, including working cross-functionally to develop and continuously assess and adapt the benefits which will be offered.

Support the annual bid submission process, including coordinating with internal stakeholders and preparing, reviewing, and/or finalizing documents for submission to CMS.

Remain knowledgeable of new and evolving requirements related to Medicare and their interface with Medi-Cal, and brief senior and executive leaders on such requirements.

Inform strategies and provide subject matter expertise in support of effective outreach, education, and enrollment efforts to recruit and retain D-SNP members.

Collaborate with the CenCal Health Compliance Department to ensure the D-SNP complies with all relevant regulatory agencies, laws, accreditation standards and regulations, and that all reports and submissions are filed timely and accurately.

Serve as subject matter expert related to the preparation for, and successful resolution of, all regulatory audits and surveys.

Attend subject-relevant conferences and represents CenCal Health in association workgroups, as requested.

Completes other projects and duties as assigned.

As a member of the Senior Leadership Team, the Medicare Director will:

Participate in cross-functional projects and work closely with Directors to achieve desired outcomes.

Provide oversight of Medicare staff, as applicable, including leading, developing, coaching, and engaging direct reports.

Prepare annual department budget and monitor expenses.

Prepare weekly, monthly, and/or quarterly reports in support of the Operations Division.

The Medicare Officer will manifest a leadership approach that is consistent with CenCal Health’s values and practices so that she or he will mobilize others to create extraordinary results and unite people to turn challenges into successes by embracing ‘The Five Practices of Exemplary Leadership’ of The Leadership Challenge:

1. Model the Way:

Clarify values by finding your voice and affirming shared values

Set the example by aligning actions with shared values

2. Inspire a Shared Vision

Envision the future by imagining exciting and ennobling possibilities

Enlist others in a common vision by appealing to shared aspirations

3. Challenge the Process

Search for opportunities by seizing the initiative and my looking outward for innovative ways to improve

Experiment and take risks by consistently generating small wins and learning from experience

4. Enable Others to Act

Foster collaboration by building trust and facilitating relationships

Strengthen others by increasing self-determination and developing competence

5. Encourage the Heart

Recognize contributions by showing appreciation for individual excellence

Celebrate the values and victories by creating a spirit of community

Qualifications

Knowledge/Skills/Abilities

Hold extensive knowledge of Medicare and Medicaid (Medi-Cal preferred) programs and understand their interface, including skills to stay abreast of evolving best practices.

Lead in a publicly accountable, transparent, and mission-driven environment and embrace the values of publicly accountable health care delivery.

Commitment to mission-driven organizations as demonstrated by required experience at health plans who are one or more of the following: part of the Local Health Plans of California, members of the Association of Community-Affiliated Plans, or not-for-profit health plans.

Influence peers through a collaborative, matrixed management approach.

Advanced knowledge of the health care industry specific to Medicare, including operations, policy, and regulatory requirements. Experience with CMS audits preferred.

Demonstrated expertise in the ability to grow, assess, refine, and improve large programs or initiatives.

Develop and champion innovative solutions to optimize programs for vulnerable populations.

Serve as an advocate for integrated programs on CenCal Health’s leadership team.

Be a thought leader and adviser to senior leaders; influence executives through experience with data and market practices.

Think strategically and problem solve.

Demonstrate strong analytical, problem solving, influencing and interpersonal skills, excellent listening, group presentation and facilitation skills.

Communicate clearly and concisely, both orally and in writing.

Utilize computer and appropriate software (e.g., Microsoft Office: Excel, Outlook, PowerPoint, Word) and job-specific applications/systems to produce correspondence, charts, spreadsheets and/or other information applicable to the position assignment.

Education and Experience

Bachelor’s degree in Business Administration, Health Care Administration, or related field.

Minimum of 8 years of experience in Medicare health plan product implementation and administration, including at least 5 years of leadership experience.

Experience in Medicaid health plan operations, with Medi-Cal experience preferred.

Experience working at a leadership level in a health care environment, including demonstrated success at leading cross-functional initiatives.

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