Medicare Strategy & Operations Leader

Excellus Health Plan Inc.; City of Rochester (NY); Hybrid; USD 79,000 - 142,000; Full time

Benefits offered by this job

Remote work option

Job summary

Excellus Health Plan Inc. is seeking a senior role to guide Medicare strategy and execution. You will ensure programs comply with design, regulatory requirements, and strategic goals while delivering excellent member experiences.

The role requires cross-functional collaboration, strong regulatory knowledge, and leadership to drive initiatives across departments. The candidate will oversee operational improvements, stakeholder engagement, and timely responses to regulatory changes, supporting the

Qualifications

• Bachelor's degree and six years of health plan operations experience required.
• Strong leadership and management experience needed.
• Experience with regulatory agencies such as NCQA, CMS, DOH and related bodies.
• Proficient in analysis, problem solving, and process improvement.
• Excellent communication and negotiation skills; ability to work independently.

Responsibilities

• Develop strategic, operational, and tactical plans for Medicare lines of business.
• Evaluate new market opportunities and build business cases.
• Identify root causes of compliance and customer-satisfaction issues.
• Collaborate with stakeholders to streamline operations and processes.
• Plan and implement projects to support product, benefit administration, and regulatory needs.
• Promote innovation and cross-functional alignment across departments.
• Serve as liaison with NYS, CMS, and BCBS as needed.
• Maintain relationships and ensure integration of Medicare strategies across teams.
• Monitor regulatory changes and adapt plans accordingly.
• Ensure privacy and compliance in all activities.

Skills

Leadership experience

Regulatory and accreditation knowledge

Strategic thinking

Problem solving

Cross-functional collaboration

Communication skills

Project management

Negotiation skills

Education

Bachelor's degree in health administration or related field

Tools

MS Word

Excel

PowerPoint

Job description

Excellus Health Plan Inc. is seeking a senior role to guide Medicare strategy and execution. You will ensure programs comply with design, regulatory requirements, and strategic goals while delivering excellent member experiences.

The role requires cross-functional collaboration, strong regulatory knowledge, and leadership to drive initiatives across departments. The candidate will oversee operational improvements, stakeholder engagement, and timely responses to regulatory changes, supporting the