Director of Operations, Medicare - Guided Medicare

Guided Medicare Solutions is an insurance agency founded in 2004 focused on offering affordable healthcare solutions. By partnering with healthcare providers and community organizations our team has established itself as one of the leading FMO's in the Medicare industry



The National Operations Director will be responsible for overseeing the day-to-day operations of the Medicare and ACA business in the United States. Reporting to the Executive Director, Medicare/ACA, this position will develop and implement operational strategies. Using proprietary and third-party technology. Manage compliance and quality assurance, contracting, hierarchies, optimize financial performance, and build and maintain strong relationships with Medicare providers and external partners


Key Responsibilities

• Develop and implement operational strategies that comply with regulatory standards and support business objectives


• Lead the development and implementation of operational policies and procedures to ensure efficient and effective Medicare and ACA plan operations


• Monitor and analyze plan performance and financial results to optimize healthcare outcomes and profitability


• Collaborate with cross-functional teams to identify areas for improvement and implement solutions


• Work with the compliance and quality departments to ensure plans adhere to all regulatory requirements and quality standards


• Build and maintain relationships with Medicare providers, vendors, and external partners to ensure optimal results


• Facilitate the development and execution of network agreements, contracting, and negotiations with healthcare providers


• Provide leadership and direction to operational teams, including hiring, training, and performance management


• Ensure timely and accurate reporting of healthcare data to regulatory agencies and other stakeholders

Qualifications

• Bachelor's degree in healthcare administration or related field


• Minimum 10 years of experience in Medicare and/or ACA operations or similar role


• Knowledge of Medicare/ACA regulations and compliance requirements


• Experience managing provider networks and negotiating contracts


• Strong leadership and interpersonal skills


• Ability to drive results and make data-driven decisions


• Excellent written and verbal communication skills


• Proven project management skills


• Demonstrated ability to work collaboratively with cross-functional teams


• Strong analytical and problem-solving skills

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