Medicare Perf. Mgmt. & Transformation Dir.

EmblemHealth; New York (NY); On-site; USD 113,000 - 211,000; Full time

Job summary

EmblemHealth in New York leads Medicare strategy and performance management across financial, operational, quality, and growth dimensions. This role translates complex analytics into actionable executive insights to guide strategic decisions.

The candidate partners across departments to shape priorities, investments, and long-term direction, driving governance, KPI reporting, and cross-functional execution to ensure a financially sound and compliant Medicare business.

Qualifications

• 10-12+ years of healthcare industry experience.
• 5+ years Medicare experience (products, regulations, economics, competitors).
• 4+ years in management consulting or equivalent structured problem-solving environment.
• Strong financial acumen including P&L tracking and enrollment forecasting.

Responsibilities

• Lead Medicare performance management and reporting with KPIs, dashboards, and scorecards.
• Drive performance improvement through gap analyses and remediation initiatives.
• Develop executive insights and presentations highlighting risks and opportunities.
• Chair governance forums and coordinate cross-functional execution.
• Support strategic execution across priority gaps and bold investments.
• Develop prioritization frameworks and business cases.
• Analyze sales, enrollment forecasts, product competitiveness for growth strategy.

Skills

Communication

Storytelling

Influence

Leadership

Cross-functional

Education

Bachelor's degree in business, Finance, HealthCare Administration, or related field

Master's (MBA) preferred

PMI Project Management certification preferred

Tools

Access

SQL

PowerPoint

Excel

Job description

Summary of Position

Lead Medicare performance management by connecting strategy and execution; and integrating data, insights, and execution across financial, operational, quality, and growth dimensions.

Translate complex analytics into clear priorities, executive-ready insights, and actionable recommendations to support strategic and operational decision-making.

Serve as a key partner in the development and execution of Medicare strategy - shaping priorities, investments, and longterm direction.

Drive performance improvement and remediation through structured governance, performance reporting (KPIs, dashboards), and disciplined execution across functional teams.

Ensure the Medicare business is financially sound, operationally reliable, compliant and market competitive.

Principal Accountabilities

• Lead Medicare Performance Management & Reporting: define, monitor and evolve Key Performance Indicators (KPIs) and develop enterprise dashboards and scorecards aligned to Medicare segment goals and establish transparent reporting to communicate goals and execution across the organization.


• Drive Performance Improvement & Remediation: conduct gap analyses; identify root causes; partner with functional teams to design, prioritize, and track remediation initiatives with measurable outcomes.


• Develop Executive Insights & Presentations: translate complex analyses into clear, concise executive-level presentations, including risks, opportunities and recommendations.


• Lead Cross-Functional Execution & Governance; chair performance governance forums; align stakeholders; establish priorities; develop project plans and ensure milestone tracking, accountability and delivery of results.


• Provide Strategic Execution Support Across Priority Gaps: flex into high-priority areas requiring additional leadership or analytical support; rapidly assess issues and drive execution to address performance or capability gaps.


• Build Strategic & Prioritization Frameworks: support strategy development through strategic assessments, prioritization frameworks, and structured evaluation of initiatives and investments.


• Support Sales, Product & Competitive Performance Analysis: evaluate sales channel performance, enrollment forecasting, product competitiveness, and market positioning to inform growth and product strategy.

Qualifications

Education, Training, Licenses, Certifications

• Bachelor's degree in business, Finance, HealthCare Administration, or related field; master's (MBA) preferred.


• Project Management certification (PMI) preferred.

Relevant Work Experience, Knowledge, Skills, and Abilities

• 10 - 12+ years of progressive experience in healthcare, with increasing scope and responsibility.


• 5+ years of Medicare experience (products, regulations, economics, competitors).


• 4+ years in management consulting or equivalent structured problem-solving environment.


• Deep understanding of Medicare P&L and key performance drivers.


• Experience across Medicare product types (MA, SNP, EGWP, PDP, Med Supp).


• Proven ability to develop and effectively utilize tables, dashboards, and performance scorecards.


• Experience conducting gap analysis, performance diagnostics, and strategic assessments.


• Experience developing prioritization frameworks and business cases.


• Strong financial acumen including P&L tracking and enrollment forecasting.


• Experience leveraging internal and external data sources (e.g., CMS data, trend reports, primary and secondary research) to drive actionable insights.


• Ability to translate complex data into clear, decision-ready insights for executive audiences.


• Proven ability to lead complex, cross-functional initiatives with project plans and milestone tracking.


• Strong communication and storytelling skills; ability to influence at all levels.


• Ability to operate effectively in a matrixed organization without direct authority.


• Experience managing people, processes, or project teams.


• Advanced proficiency in Excel.


• Experience with Access, SQL, or similar data tools.


• Expertise in PowerPoint and executive-level presentation development.


• Enthusiasm for engaging with AI solutions (e.g., Co-Pilot) to enhance and expedite all deliverables.

Additional Information

• Requisition ID: 1000003204


• Hiring Range: $113,400-$210,600