DentaQuest
Medicare Advantage Performance Manager (Remote) (Finance)
At DentaQuest, we believe that everyone should live life free of dental disease. As a purpose-driven, double bottom line company that is improving oral health for everyone, we are transforming the oral health system – from the way we provide care and pay for it, to how we talk about it and prioritize it in our policies and communities.
Meaningful change requires a revolution in oral health. We are redefining what it means to prevent disease and provide better access to care for everyone. We are going beyond the dental chair to reshape the oral health system, addressing total health and the social and cultural factors that impact it.
To make this revolution a reality, we harness our unique reach and insights to advance policy, financing, care, and the community. That means solving problems in a flexible and efficient way, testing and trialing to create new solutions and delivering measurable outcomes for the people we serve.
The people of DentaQuest have a common purpose, and we work together with passion, perseverance and focus to achieve a nation where no child suffers from the pain of tooth decay. Where adults keep all their teeth for their entire lives. Where every person has access to quality dental care.
The Medicare Advantage Performance Manager will oversee all DentaQuest Medicare Advantage business. This leader will be solely focused on the performance of current and future Medicare Advantage clients. This position will oversee the performance of 30+ clients, 100+ product designs, 1 million+ members, and a line of business with revenue over $100 million. This leader will work across the organization to ensure that we are appropriately administering the Medicare Advantage business. This leader will also work closely with our Sales and Capture teams to be the Medicare Advantage expert that assists in retaining and growing the business. This leader will be responsible to ensure continued growth, improved financial performance, and appropriate administration of the Medicare Advantage line of business. PRIMARY JOB RESPONSIBILITIES:
• Serve as the leading enterprise-wide expert for the Medicare Advantage line of business at DentaQuest.
• Establishes strategic relationships with key Medicare Advantage clients that allow for optimal performance and growing/expanding partnerships.
• Work closely across the organization to ensure that we are bringing market-leading administration and performance to our Medicare Advantage clients.
• Serve as a leading Medicare Advantage expert internally to ensure we are delivering best practices across all functional areas.
• Partners with our sales and client engagement teams to grow and retain our business.
• Partner with the VP of Medicare Advantage and National Accounts to manage the financial performance of the line of business and monitor/optimize specific client performance.
• Manage the financials of existing and prospect Medicare Advantage clients. When necessary, closely work with clients to ensure appropriate financial performance for mutually beneficial outcomes. This includes looking at each client's performance by region and product and developing plans to improve.
• Acts as the business lead with the Medicare Advantage Center of Excellence (MA COE) that is being built to cover all components of Medicare Advantage administration (call center, claims, complaints, grievances, appeals, utilization management, etc.). This leader will not oversee MA COE, but will be the business liaison to this area to ensure compliant administration and optimal performance.
• Provide subject matter expertise and leadership to Sales and Capture to expand our footprint of Medicare Advantage clients.
• Work very closely with the Client Engagement and National Accounts team to serve as an industry expert in Medicare Advantage with all of our clients.
• Prepare Medicare Advantage line of business dashboards that closely track the performance of the line of business and the work being performed to continue to enhance our performance. This information will be shared monthly across the organization.
• Prepare Medicare Advantage line of business presentations that build off the dashboards and show a clear and specific strategy to enhance each line of business. This information will be required for Executive Leadership Team and Board of Directors awareness, support, and buy-in.
• Development of client presentations for new business, existing business, strategic growth
• Coordination with Sales and Capture for client/market growth, rate and other strategies
• High level meetings with clients (Directors+) to discuss growth and performance
• Lead escalated client discussions
• Take strategic communication from Senior Leadership Team for Medicare Advantage line of business and communicate to and integrate with Operations leadership into their programs
• Take strategic communication from Senior Leadership Team for Medicare Advantage line of business socializing to the rest of the organization
• Work with Operations leadership to establish a program including Operations HC and budget transfer as needed to design Medicare Advantage capability in their division
• Oversight of Medicare Advantage client performance and management of necessary changes to optimize
• Liaison/Expert with CE and National Accounts to address client needs
• Assess organization capability to provide Medical Advantage services and non-Operations areas (IT) and work with leaders to resolve gaps
• Create and maintain organizational view of Medicare Advantage line of business for OCEO and Finance including risk reward, projections, opportunities, losses, leading indicators, etc.
• Stays on top of industry and compliance trends for Medicare Advantage as the internal expert
• Provide leadership and supervision to assigned staff.
• Responsible for staff hiring, as well as the determination and implementation of performance and wage evaluations, performance improvement plans, disciplinary processes, and terminations for local staff, in accordance with company policy and in concert with Human Resources.
• Provide leadership and supervision to assigned staff.
• Perform other duties, as assigned
JOB QUALIFICATIONS:
Required:
• Bachelor's degree in business, healthcare administration or related field required (or equivalent work experience).
• 8+ years of experience in healthcare network development/ contracting understanding of network adequacy strategies
• Demonstrated expertise in the dental and vision industry
• Demonstrated expertise in the Medicare Advantage industry
• Demonstrated expertise with Medicare Advantage Organizations (MAOs) along with desired partnership with First Tier, Downstream and Related Entities (FDRs) to administer supplemental benefits (dental, vision, etc.)
• Medicare Advantage working knowledge on federal and state regulations
• Large and complex project leadership experience
• Solid analytical and presentation skills, including advanced PowerPoint and Excel experience
• Up to 25% travel
• Attends additional training as requested/deemed necessary
PHYSICAL DEMANDS:
• Ability to work in a traditional professional office setting/remote environment.
• Work schedule may vary and is determined by project schedules.
• Ability to efficiently operate all job-related office equipment (computer, telephone, etc.)
• Incumbent must be able to communicate effectively.
• Requires overall light physical effort (up to 25lbs.)
• Manual dexterity and sitting is required in carrying out position responsibilities (i.e. use of personal computer).
• Ability to travel or move about within and outside serviced facilities required.
• Incumbent works primarily in either a private or shared office environment.