Your Role
The Group Medicare team oversees all aspects pertaining to the strategy, enrollment growth, day-to-day management, retention, compliance, and financial performance of Blue Shield of California’s Group Medicare membership. The Director, Group Medicare will report to the Senior Director, Medicare Growth. In this role you will be responsible for developing and executing on the strategic growth plan for our Group Medicare product, representing a critical and growing membership base. Accountabilities will include retention, financial targets, Medicare Stars, and Risk Adjustment for client accounts in this product. Another critical accountability will be building and maintaining the operational infrastructure through matrixed relationships to support Medicare Advantage PPO in preparation for a state-wide launch of the product. This role is critical to Medicare and Blue Shield achieving our long-term strategy goals. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
Your Work
In this role, you will:
- Develop and execute short and long-term strategic growth plan for Group Medicare, including meeting sales/retention targets and financial operating income goals
- Lead matrix relationships within Blue Shield related to Group Medicare accounts to build infrastructure around the PPO product, including capabilities around member engagement, operations, and utilization management; this includes leading governance process and ongoing oversight of Group Medicare capabilities and overseeing workstreams and deliverables to ensure Blue Shield delivers on Group Medicare quality, membership, and OI outcomes
- Manage a team of professionals to ensure the Group Medicare business meets its business goals in a compliant manner
- Support Commercial Account Executives who manage overall relationships with accounts and consultants, represent Blue Shield in final round bid interviews and ongoing client meetings to understand their needs and ultimately retain client accounts, may also lead open enrollment meetings for key accounts
- Consult with Commercial clients on Medicare line of business to drive member outcomes which result in meeting client’s goals and objectives while achieving corporate goals, and build out specific client outcomes to report-out to show our effectiveness in Medicare Stars and risk adjustment scores
- Achieve or exceed Operating Income goals for BSC’s Group Medicare membership
- Achieve or exceed operational, quality (Medicare Stars), retention, and risk adjustment goals for client accounts
Your Knowledge and Experience
- Requires a bachelor's degree in business, marketing, communication or equivalent experience
- Requires at least 10 years of prior relevant experience including 6 years of management experience
- Requires 10 years of experience in Medicare with at least 5 years managing or working with Group Medicare accounts and/or Account Management for Group Medicare accounts at a manager or higher level
- Requires experience working on Medicare Advantage products, including the annual bid process
- Prior experience working with Medicare Advantage PPO product and membership preferred
Pay Range:
The pay range for this role is: $165,990.00 to $248,930.00 for California.
Note:
Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.