San Francisco Health Plan · 20 hours ago
Manager, Medicare Programs
San Francisco, CA
Full-time
Hybrid
Mid, Senior Level
$113K/yr - $133K/yr
5+ years expSan Francisco Health Plan (SFHP) is an award-winning managed care health plan dedicated to providing affordable health care coverage to underserved residents in San Francisco County. The Manager, Medicare Programs will oversee the development lifecycle of the SFHP Care Plus product, ensuring compliance with regulatory requirements and supporting operational performance while leading process improvements and program management efforts.
Health Care
Responsibilities
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
Qualification
Required
Bachelor's degree in public health, administration, business, or other related areas; or equivalent work experience
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
Preferred
Masters degree preferred
Benefits
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.
Company
San Francisco Health Plan
San Francisco Health Plan is a community health plan that provides affordable & high-quality health care coverage for San Franciscans.
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
John F. Grgurina Jr.
CEO
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