Medicare Plan Management Principal

Blue-Cross-Blue-Shield-Association; Chicago (IL); Hybrid; USD 142,000 - 192,000; Full time

Job summary

Blue-Cross-Blue-Shield-Association seeks a senior strategist to design and execute plan-facing strategy for the Medicare Advantage program. This leader will architect engagement, education, and activation across BCBS Plans, translating national direction into actionable, plan-level initiatives that improve adoption and performance.

The role requires deep knowledge of Star Ratings, Risk Adjustment, and Medical Cost Management, with proven leadership in healthcare strategy and stakeholder

Qualifications

• BS in Business Administration or related field or equivalent experience.
• 10+ years in healthcare strategy, managed care, or health plan operations, with at least 3 years in a leadership role.
• Deep familiarity with Medicare Advantage program structure (CMS Star Ratings, RAF/HCC, medical cost management); FEHBP/FEP knowledge desirable.

Responsibilities

• Lead the design and execution of plan-facing strategy for the Medicare Advantage program and act as the primary relationship owner between BCBSA and Plans.
• Oversee go-to-market planning, communications design, change management, and capability building for plan engagement.
• Develop governance-aligned plan participation structures, accountability mechanisms, budgets, and performance metrics; manage plan communications and stakeholder briefings.

Skills

Leadership

Stakeholder management

Presentation skills

Negotiation

Strategic planning

Change management

Team management

Communication

Decision making

Organization

Budgeting

Education

BS in Business Administration or other business discipline or equivalent work experience

Tools

Microsoft Word

PowerPoint

Job description

The role leads the design and execution of plan-facing strategy for the Medicare Advantage program. This leadership role serves as the primary architect of how BCBSA engages, educates, and activates BCBS Plans participating in the national MA program — translating national program strategy into actionable, plan-level initiatives that drive adoption, performance improvement, and sustained operational alignment.The role will build and steward the full lifecycle of plan relations: from go-to-market planning and communications design, through change management execution and capability building, to ongoing engagement frameworks that hold plans accountable and support their success. This role requires a rare blend of strategic vision, healthcare program expertise, stakeholder influence, and the ability to translate complex program requirements — spanning Star Ratings, Risk Adjustment, and Medical Cost Management — into clear, compelling guidance that Plans can act on.Serve as the primary relationship owner between BCBSA and the Plans for the national Medicare Advantage program by liaising with Plan contacts, ensuring satisfaction, aligning business processes with strategic goals, overseeing strategy sessions, policy development, and performance metrics, approving budget activities, updating stakeholders, coordinating support teams, and assessing technological efficiencies. Develop and own the annual go-to-market strategy for plan engagement, nuanced for Plan-tier differentiation. Lead the design of Plan participation structures and accountability mechanisms tied to governance.Represent BCBSA in Plan-facing forums and facilitate constructive dialogue. Lead change manage strategy for program evolution, ensuring Plans are prepared for, engaged with and supported through operational, regulatory and strategic transitions.Design and manage a comprehensive plan communications architecture –including regular reporting cadences, performance updates, policy notifications, and strategic briefings. Ensure clear and efficient communication with Plans and stakeholders. Build and maintain a plan-facing resource library—including playbooks, reference guides, training, and self-service tools. Promptly address Plan issues, offering support and information as needed. Oversee issue resolution with comprehensive accountability. Relay Plan intelligence summaries to senior leadership. Support BOM/BOD governance processes by preparing plan-facing communications and briefing materials to contextualize performance outcomes and program expectations.Oversee approval of Plans’ administrative cost budgets, ensuring adherence to Federal contract limits and managing annual variations in costs.Lead and manage a team with the aim of driving effective performance management, fostering professional growth, and creating a positive and inclusive work environment. This role is dedicated to utilizing strong leadership and communication skills to motivate and inspire team members, ensuring they are aligned with and committed to achieving the organization’s goals.The posting range for this position is:141,980.27 - 192,006.76Qualifications:EducationRequired BS in Business Administration or other business discipline or equivalent work experienceExperienceRequired 10+ Years of experience in healthcare strategy, managed care, or health plan operations, with at least 3 years in a leadership level roleKnowledge Skills and AbilitiesEssential understanding of FEHBP, including its structure, regulations, and operations for effective management.Deep familiarity with Medicare Advantage program structure, including CMS Star Ratings, Risk Adjustment (RAF/HCC), and medical cost management strategies; knowledge of FEHBP and FEP program structure highly desirable.Adaptability to FEHBP changes and strategy adjustments as well as adaptability to Medicare Advantage regulatory changes, CMS policy updates, and FEP MA program strategy adjustments in a first-of-its-kind program environment.Proficiency in Microsoft Windows, Word, and PowerPoint for communication and presentations.Leadership skills to build, motivate, and manage teams, fostering collaboration and resolving conflicts.Strategic alignment of team efforts to achieve objectives and results.Independent decision-making skills for complex situations.Skilled negotiation with external stakeholders like BCBS Plans to maintain positive relationships.Effective presentation skills for clear and engaging communication to various audience sizes.Ability to gain external customers' understanding and buy-in through compelling presentations.Excellent organizational skills for administrative tasks, budgeting, and timeline management.Meticulous attention to detail for accuracy, CMS program compliance, and FEP MA governance accountability.Extra Posting Information:#LI-HybridThe posted salary range is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the hiring range and this hiring range may also be modified in the future. A candidate’s position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs. This job is also eligible for annual bonus incentive pay.We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees.Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.