Director, Governmental Products & Enrollment

Date: Jul 20, 2021

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

Job Requisition ID: 5405 

 

Position Summary/Position

 

Under the direction of the VP of Strategy, the Director of Governmental Products & Enrollment will be responsible for the development and implementation of a strategic Medi-Cal Enrollment plan and Medicare Sales plan to grow plan membership and achieve at least 90% Medi-Cal market share in the Inland Empire and the largest not-for-profit Medicare-Medicaid Plan in the nation. In addition, this position will lead the revenue optimization initiative by collaborating with internal departments and external agencies to ensure that eligible IEHP Members can gain their Medicare benefit or are assigned with a proper Medi-Cal category of aids. This leadership position will continue to cultivate strategic partnership with key partners, including county Medi-Cal offices, the federal Social Security Administration offices, the Department of Health Care Services, and health plan partners. In addition, the Director of Governmental Products & Enrollment will lead the development of key Product materials to meet the regulatory compliance and support enrollment strategies. 

Major Functions (Duties and Responsibilities)

 

1. Lead and motivate Product Management, Medi-Cal Enrollment Assistance, Revenue Optimization, and Medicare Enrollment teams to recognize and reach their potential to achieve organizational and department’s goals and deliver exceptional customer services.
2. Be an extraordinary example and a champion for Teams in living and practicing IEHP’s Mission, Vision, and Values every day, and strongly align and support organization’s strategic plan.
3. Lead the development and implementation of a strategic Medi-Cal Enrollment plan (in partnership with the Communications & Marketing department) that includes strategies to drive calls from potential Members to the Enrollment Assistance Call Center, optimize the Medi-Cal application conversion, and achieve at least 90% IEHP Choice rate.
4. Lead the development and implementation of a strategic Medicare Sales plan that includes strategies to drive calls from individuals with both Medicare and Medicaid (called “dual eligible”) to the Medicare Enrollment Team, outreach to IEHP’s existing dual eligible Members to inform them about the Medicare product, and ensure that IEHP continues to be the largest not-for-profit Medicare-Medicaid Plan in the nation.
5. Drive the revenue optimization initiative by collaborating with applicable internal departments and external eligibility agencies to ensure eligible IEHP Members can gain Medicare eligibility and/or are placed in the right Medi-Cal category of aids.
6. Partner with the Riverside and San Bernardino County Medicaid offices on eligibility improvement opportunities such as assignment of a proper Medicaid aid code for IEHP Members, addition of a newborn to existing IEHP Member’s case, demographic updates, removal of Medicaid Expansion aid code from individuals with both Medicare and Medicaid, and many more.
7. Communicate enrollment strategies and membership implications to Provider Services, Member Services, Health Services, and other departments across the organization for service readiness.
8. Collaborate with health plan partners on assigned strategic initiatives.
9. Lead the identification, development, and execution of key Product member materials such as Provider Directories, Welcome Kits, Enrollment Kits, Open Enrollment Kits, NCQA Evidence, Evidence of Coverage, and other assigned materials to the meet the regulatory compliance and support enrollment strategies.
10. Support the initiation, development and implementation of new products or new businesses as needed.

Supervisory Responsibilities

Leader: Administers Hires, Terminations, and Performance Reviews

Experience Qualifications

 

7-10 years of experience with progressive responsibilities in healthcare industry. At least 5 years of leading and managing a Product Management/Development or Enrollment/Sales team. Experience in the development and implementation of the marketing and enrollment strategies. Have a demonstrated experience in working with the Medicaid or Medicare eligibility agencies such as the County Medi-Cal offices, the federal Social Services Administration offices, or health plan partners for the purpose of enrollment or strategic partnership.

Preferred Experience

 

Experience with progressive responsibilities in healthcare industry preferably Medicaid and Medicare managed care setting.

Education Qualifications

 

Bachelor’s degree from an accredited institution required.

Preferred Education

 

Master’s degree from an accredited institution preferred.

Drivers License Required

Yes, must have a valid California Driver's License.

Knowledge Requirement

 

Possess strong knowledge of the development and implementation of a strategic marketing and/or enrollment/sales plan for Medicaid and/or Medicare products. Thorough knowledge about the regulatory requirements of the Medicaid and/or Medicare Marketing and Sales practices. Thorough knowledge about the Medicaid and/or Medicare eligibility criteria and general Medicaid and/or Medicare-Medicaid managed care eligibility requirements. Understanding and sensitivity to a multi-cultural environment and community.

Skills Requirement

 

Must have a strong strategic mindset and A3 problem-solving skill. Strong leadership skills in leading and motivating a diverse Team to achieve the common goal(s). High project management and communications skills. Developing new relationship opportunities with external entities and grow existing ones to advance the membership or strategic partnership goal. Excellent writing, interpersonal, and communications skills.

Abilities Requirement

 

Ability to work in a matrix-based organization. Must have a high degree of patience and attention to detail.

Commitment to Team Culture

 

The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.

Working Conditions

 

General office or virtual office environment; using computer keyboard and screens; travel within California and other states if needed.

Physical Requirements

Keyboarding: Traditional - FREQUENTLY
Keyboarding: Touch-Screen - FREQUENTLY
Keyboarding: 10-Key - FREQUENTLY
Hearing: One-on-One - FREQUENTLY
Communicate: Information/ideas verbally - FREQUENTLY
Near Visual Acuity - FREQUENTLY
Sitting - CONSTANTLY
Lighting - CONSTANTLY
Indoors - FREQUENTLY
Regular contacts: co-workers, supervisor - FREQUENTLY
Memory - FREQUENTLY
Understand and follow direction - FREQUENTLY
Regular and reliable attendance - CONSTANTLY

 

Starting Salary: $144,976.00  - $184,849.60  

Pay rate will commensurate with experience

 

Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region. With a provider network of more than 6,000 and a team of more than 2,000 employees, IEHP provides quality, accessible healthcare services to more than 1.2 million members. And our mission and core values help guide us in the development of innovative programs and the creation of an award winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and Make a Difference with us! IEHP offers a Competitive salary and a benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and retirement plan.

 


Nearest Major Market: Riverside
Nearest Secondary Market: Los Angeles