Medicare Product Development Director

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.

Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a consciously inclusive environment where diversity is celebrated.

We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more.

Reporting to the Vice President, Medicare Advantage Sales & Product, the Director, Medicare Product Development leads a team responsible for developing and implementing new and innovative products, features, and services across all targeted market segments to support corporate goals.

This role is responsible for leading product development for key product initiatives from business case development through implementation. This is a highly visible, self-directed position, with exposure to all levels of management. They will collaborate with internal departments including Strategy, Sales, Finance, Actuarial, Compliance, Marketing, Corporate Communications, IT, Configuration, Provider Network Management, EPMO, Customer Service, as well as MGB Population Health and other MGB teams to vet, assess and implement opportunities.

Responsibilities:

• Lead a structured approach for developing and implementing new products, services, features, and enhancements responding to segment needs to achieve desired membership and profitability goals and customer experience targets
• Define and manage the annual product development roadmap and workplan based on corporate product strategies, client / sales / market needs and regulatory requirements.
• Work closely with the Director, Product Operations on product lifecycle and product roadmaps for new product initiatives and existing product lines.
• Collaborate with key business partners including Sales, Benefits Administration, IT, Marketing, Compliance, Customer Service, Provider Contracting, Clinical and others to ensure alignment on product initiatives across the organization
• Leads and directs strategic efforts and ensures execution of responsibilities for the Medicare bid process driving efforts with CMS, DOI, and appropriate state agencies while collaborating with Compliance, Finance, Pharmacy and other related departments to ensure all filings are handled in an appropriate and expeditious manner, guaranteeing the favorable outcome of the bid process.
• Leads all bid related submissions to CMS by coordinating all required data delivery, completion of the Bid in the CMS PBP as well as all related CMS Bid desk review and CMS Bid Audit activities.
• Acts as the main liaison with our actuary for all BID assessment and coordination as well as for any ad hoc financial or viability studies.
• Responsible for developing and maintaining vendor relationships, including leading contract negotiations up to a fully executed contract.
• Serves as a subject matter expert of CMS Chapter 4 which regulates Medicare Advantage benefits and product design requirements for both Individual and Group products and champions development of the guidelines related to CMS guidance on existing and new products and product-related bid requirements, certificates, and riders.
• Provides business oversight and expertise of new member materials development that include product information, certificate, and rider language when appropriate, and ensures they have met legal and compliance approval and have been filed with the CMS or DOI, as appropriate.
• Lead team in development of business cases for new product/service proposals, including needs assessments, cost/benefit analysis and financial/operational impacts.
• Assess company capabilities and identify ways (build/buy) to develop competency (if needed) to support product introductions and in-market success.
• Drive implementation of key products, services, features, and enhancements, partnering with the EPMO on work planning, scoping, and implementation oversight
• Collaborate with IT, Operations, Contracting, Customer Service, LRAC and other internal departments to ensure that new product/service innovations can be built and administered simply and efficiently
• Provide business leadership and subject matter expertise during product implementations
• Communicate effectively across various levels of the organization and serve as a central point for effective and efficient product development and implementation
• Serve as a primary interface with external partners, vendors and stakeholders during product development and implementation; establish and maintain effective relationships with these external entities
• Collaborate with Sales and Marketing to develop clear, differentiating value propositions for product/service introductions, ensuring that market and voice of the customer insights are incorporated into the value propositions
• Collaborate with Sales and Marketing to develop Go-to-Market plans for new products and services
• Meet, or exceed, internal and external customer expectations and requirements; establish and maintain effective relationships with customers and gain their trust and respect
• Conduct lessons learned and develop and maintain best practices
• Identify and create the processes and align resources to accomplish key objectives; clearly convey and assign clear accountability for important objectives, deadlines, and expectations.
• Motivate and encourage staff, lead through change and adversity. Make decisions as needed and build consensus as appropriate. Communicate and cascade information to employees in a timely manner and actively participates in the success of cross-organizational programs and initiatives.
• Set clear goals and objectives and uses metrics to measure performance and hold staff accountable. Provide coaching to improve performance and hold regular development discussions with direct reports. Recognize staff for their contributions.
• Hire participate in and/or recommend development measures and disciplinary actions up to and including termination, evaluate performance, and supervise the work of all direct and indirect reports following established organizational policies, procedures, and practices.
• Set clear goals and objectives and use metrics to measure performance and hold staff accountable. Provide coaching to improve performance and holds regular development
• Ability to lead cross functional teams, drive decision-making and ensure end to end operational integrity of product implementations and/or product enhancements
• Inform, engage, inspire, motivate, and actively listen to employees.
• Persist in accomplishing objectives, despite obstacles and setbacks to consistently achieve results.
• Develop and maintain workplans, documentation and job aids for key functions and processes performed by the team
• Hold self and others accountable to meet commitments.
• Ensure diversity, equity, and inclusion are integrated as a guiding principle.
• Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise.
• Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization.
• Other duties as assigned with or without accommodation.

Qualifications:

• Bachelor’s degree in health care administration, business required or the equivalent combination of training and experience, plus 7-10 years of related experience.
• Knowledge of insurance contracts, health insurance or managed care products, HMP or health insurance benefit design and underwriting principles applied to health care.
• Master’s degree preferred.
• Direct health care/health insurance experience highly preferred.

Skills/Abilities/Other Details

• Demonstrate Mass General Brigham Health Plans core brand principles of always listening, challenging conventions, and providing value.
• Bring fresh ideas forward by listening to and working with employees and the people we serve.
• Respect the talent and unique contributions of every individual and treat all people in a fair and equitable manner.
• Strong, demonstrated track record of an ability to execute on time, on budget, and on scope.
• Strong aptitude for technology-based solutions.
• Ability to inject energy, when and where it’s needed.
• Current in healthcare trends.
• Demonstrated forward, visionary thinking; ability to see “what is” and envision “what could be.”
• Ability to develop, introduce, defend, and gain support for a new ideas and approaches.
• Excellent leadership skills and leadership track record.
• Ability to translate and communicate complex topics in a variety of forums, tailoring communications to effectively fit and influence the targeted audience, strong executive presence, presentation, and communication skills. Strong verbal, active listening, and written communication skills required.
• Ability to view the long-range trends and cycles of the business and industry and see the “big picture.”
• Ability to apply a variety of strategic frameworks to analyze problems and to guide and develop solutions.
• Ability to challenge the status quo and drive innovative thinking and the capability to successfully implement strategy.
• Excellent interpersonal skills, including the ability to influence others at all levels of an organization.
• Strong EQ; exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback.
• Unquestionable integrity.
• Provides guidance to Network Management teams based on organizational goals and company policy.
• Motivates and encourages staff; leads through change and adversity. Makes decisions as needed and builds consensus as appropriate. Communicates and cascades information to employees in a timely manner and actively participates in the success of cross-organizational programs and initiatives.
• Sets clear goals and objectives and uses metrics to measure performance and hold staff accountable. Provides coaching to improve performance and holds regular development discussions with direct reports. Recognizes staff for their contributions.
• Inform, engage, inspire, motivate, and actively listen to employees.
• Make decisions that put the needs of the people we serve—our members, providers, brokers, and employers—front and center.
• Communicate and cascade information to employees in a timely manner and actively participate in the success of cross-organizational programs and initiatives.
• Identify/create processes and align resources to accomplish key objectives; clearly convey and assign clear accountability for important objectives, deadlines, and expectations.
• Hire, participate in, and/or recommend development measures and disciplinary actions up to and including termination; evaluate performance and supervise the work of all direct and indirect reports following established organizational policies, procedures, and practices.
• Set clear goals and objectives, use metrics to measure performance, and hold employees accountable. Provide coaching to improve performance and holds regular development meetings.
• Ensure diversity, equity, and inclusion are integrated as a guiding principle.

As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community. We place great value on being a diverse, equitable and inclusive organization as we aim to reflect the diversity of the patients we serve. At Mass General Brigham, we believe in equal access to quality care, employment and advancement opportunities encompassing the full spectrum of human diversity: race, gender, sexual orientation, ability, religion, ethnicity, national origin and all the other forms of human presence and expression that make us better able to provide innovative and cutting-edge healthcare and research.

EEO Statement

Mass General Brigham is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.

Disclaimer

The above statements are intended to describe the general nature and complexity of the work being performed by personnel assigned to this classification and do not represent an exhaustive list of all tasks, duties, and responsibilities required of personnel assigned to this position.