Job Description

Job Location: Main Office - Santa Barbara, CA 93110
Position Type: Full TimeEducation
Level: Bachelor's Degree
Salary Range: $120,970.00 - $181,455.00 Salary/year
Travel Percentage: None
Job Category: MedicareCentral Coast
Salary Range: $120,970 - $181,455 Annually
Job

Summary
The Medicare Program Manager provides essential program and operational support to CenCal Health CareConnect’s Dual Eligible Special Needs Plan (D-SNP). This role is responsible for leading, coordinating, and executing cross-functional operational initiatives that advance CenCal Health’s Medicare program. Core responsibilities include:
- Medicare Program Leadership & Strategy Execution
- Lead and support the operational execution of CenCal Health CareConnect’s D-SNP Medicare program by coordinating cross-functional initiatives that advance program viability, performance, and strategic goals.
- Cross-Functional Coordination & Governance Facilitation
- Serve as the central operational point of contact for Medicare governance bodies and D-SNP workgroups, including planning, facilitating, and supporting recurring meetings (e.g., Operations Meetings, Steering Committee) and ad hoc cross-functional forums.
- Program Management & Operational Oversight
- Drive Medicare program activities by managing workplans, tracking milestones and deliverables, identifying and mitigating risks, and ensuring timely execution across the Medicare line of business.
- Continuous Improvement & Operational Excellence
- Support ongoing program improvements by identifying operational gaps, facilitating solutions across departments, and promoting best practices that strengthen Medicare program effectiveness and compliance.
Duties and Responsibilities
1. Medicare Program Leadership & Strategy Execution - (Driving Medicare program direction, product development, and strategic initiatives)
- Assist the Medicare Director in annual Medicare bid development in collaboration with Actuarial, Finance, and Product teams.
- Support the management and implementation of supplemental benefits, ensuring alignment with operational readiness and member communications.
- Assist the Medicare Director in the development and refinement of D-SNP workflows and operational processes.
- Support continuous improvement and compliance initiatives related to the Medicare product, including regulatory updates, policy changes, and operational enhancements.
- Obtain senior management approval for the D-SNP product by presenting the product charter, including high-level costs and benefits.
2. Cross-Functional Coordination & Governance Facilitation - (Facilitating governance bodies, workgroups, and cross-departmental alignment)
- Serve as the operational program manager for Medicare governance bodies, including D-SNP Operations Meetings, Governance Committee, and focused workgroups.
- Develop agendas, compile background materials, and track follow-up items to support effective governance meetings and decision-making.
- Monitor progress on governance action items and ensure accountability across departments.
- Establish alliances with departments and organizations by identifying dependencies and securing partnership commitments.
- Facilitate cross-functional collaboration to ensure clear communication, aligned responsibilities, and timely issue resolution.
- Manage relationships with project sponsors and team members through meetings and status updates.
3. Program Management & Operational Oversight - (Planning, execution, tracking, and delivery of Medicare initiatives)
- Manage multiple concurrent Medicare initiatives to ensure successful execution, on-time delivery, and scope alignment.
- Develop, maintain, and track operational workplans, timelines, action items, risks, and deliverables across Medicare workstreams.
- Prepare program status updates, dashboards, and presentations for leadership, steering committees, and internal partners.
- Collaborate with the Enterprise Project Management Office using standardized project management tools and templates; assist and educate department leads on project management practices.
- In collaboration with Operational Excellence, model and implement project management methodologies across the project lifecycle.
4. Continuous Improvement & Operational Excellence - (Strengthening processes, compliance, reporting, and operational effectiveness)
- Support development and maintenance of Standard Operating Procedures (SOPs) and Policies & Procedures (P&Ps).
- Maintain governance documentation and records to support audits, regulatory reviews, and internal oversight.
- Assist with data gathering, analysis, and reporting for CMS, State, and internal requirements.
- Support development and maintenance of program dashboards and performance reports.
- Monitor CMS guidance and HPMS memos and track operational impacts.
- Perform other duties as assigned in support of Medicare product operations and organizational priorities.

QualificationsKnowledge/Skills/Abilities
Required
- Strong verbal and written communication skills with the ability to clearly convey information and ideas to diverse audiences.
- Demonstrated ability to prioritize competing demands, manage resources effectively, and adapt to evolving business needs.
- Proven ability to build and maintain constructive, collaborative working relationships across all levels of the organization.
- Experience representing the organization and providing information to internal and external stakeholders, including customers, regulatory entities, and business partners.
- Demonstrates high ethical standards, integrity, and alignment with organizational values; inspires trust and credibility.
- Supports team development by recognizing contributions, fostering collaboration, and promoting a positive, respectful work environment.
- Experience managing complex, multi-faceted projects, including both short- and long-term initiatives with varying team sizes.
- Strong interpersonal and facilitation skills, including the ability to lead meetings, resolve issues, and influence outcomes through problem-solving and persuasion.
- Ability to motivate and lead participants at all organizational levels without direct authority.
- Working knowledge of project management methodologies, tools, and best practices.
- Self-motivated with the ability to exercise sound independent judgment and decision-making.
- Demonstrated ability to work cooperatively to set goals, resolve problems, and make decisions that enhance organizational effectiveness.
- Excellent organizational and time management skills, with a proven ability to manage multiple projects concurrently.
- Strong analytical and critical thinking skills, with the ability to identify risks, develop solutions, and mitigate potential issues.
- Ability to effectively manage and support organizational change.
- Proficient decision-making, problem-solving, listening, and independent thinking skills.
- Proficiency in Microsoft Office applications and experience using project planning and tracking software.
- Knowledge of and experience with the software development life cycle (SDLC)
Preferred
- Extensive knowledge of the core operational functions of a managed care organization.
Education and Experience
- Bachelor’s degree (or equivalent) in business, healthcare, technology, or a related field; an equivalent combination of education and relevant experience may be considered.
- Ten (10) or more years of related experience managing complex projects and/or programs.
- Project Management Professional (PMP®) certification required.
- Program Management Professional (PgMP®) certification preferred.
- Experience in Medicare program management or leading Medicare-related initiatives preferred.