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Director - Medicare Advantage Operations - (27414)

Universal Health Services
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Deltek Talent Management - Director - Medicare Advantage Operations - (27414)

Job Details

Director - Medicare Advantage Operations - (27414)

Facility Name
Prominence Health Plan
RENO, NV 89502 US (Primary)
Career Area
Job Description

Founded in 1978, Universal Health Services, Inc. (UHS)* is one of the nation’s largest and most respected healthcare management companies, operating through its subsidiaries—acute care hospitals, behavioral health facilities and ambulatory centers nationwide. With more than 74,000 people employed by UHS subsidiaries, UHS’s business strategy is to continue to grow by building or purchasing healthcare facilities across the country, while continuing to strengthen UHS’s well-reputed franchise with its customary exceptional service and effective cost control. Our success is driven by a service philosophy based on integrity, competence, compassion, and a responsive management style. UHS has been recognized as a Fortune 500 company and is listed as one of Fortune’s Most Admired Companies. UHS’s Acute Care Division is comprised of 25 high performing hospitals and several ambulatory care facilities across the nation and prides itself on providing superior patient care. 

Prominence Health Plan, established in Reno in 1993 as St. Mary’s Health Plan, was acquired in 2014 by Universal Health Services (UHS), one of Fortune Most Admired Companies. 

In addition to the HMO, Prominence Health Plan also offers Point of Service health plans, a preferred health insurance company that offers Preferred Provider Organization (PPO) health plans, and CDS Group Health, a third-party administrator.

We are a fast-growing, rapidly-changing healthcare organization offering the excitement of a start-up with the support of a Fortune 500 company. We are looking for talented, enthusiastic people to help shape the future of our organization.

Job Summary:  The Director, Medicare Advantage has accountability for Medicare Advantage operations working cooperatively with internal functional areas and contracted partners. The Director will hold product accountability for all aspects of the Medicare Advantage product in all markets and works with the Medicare Compliance Officer to monitor the compliance program.  The Director will serve as subject matter expert and public spokesperson on all Medicare Advantage matters, serve as the CMS contact person, and participate in the strategy development within Prominence and UHS that will shape the expansion of Medicare Advantage to other markets and additional products.  The Director will manage the bid process, lead operational strategies and tactics to achieve at least a 4 Star rating, ensure appropriate risk scores, and achieve NCQA accreditation for the Medicare Advantage product. The incumbent will be responsible to identify staffing, logistics, technical, and programmatic resources needed within Prominence to build the necessary capacity and capability within budgetary guidelines.

Job Requirements

Regulatory Requirements:


  • Bachelor’s degree in Health Administration, Business or related field.  Master’s preferred


  • Seven + years’ experience in  Medicare Advantage operations in a health plan setting


·         Significant Medicare Advantage operations leadership experience with proven track record of building Medicare Advantage programs.



Language Skills:


·                    Ability to effectively communicate in English, both verbally and in writing.




·         Proven ability to establish sustainable relationships with CMS, third-party partners, and internal functional areas.



·         Deep understanding of health care delivery and financing, its component parts, and their inter-relationship for alignment of incentives and information that will positively impact the performance of the Medicare Advantage program.




·         Strong analytical skills which enable the identification of revenue opportunities and the establishment of practical and actionable paths, both internally and externally that will lead to desired outcomes. Ability to drill down within quantitative and qualitative analysis, both individually and in concert with others to problem solve and define clear paths of corrective action.



·         Excellent familiarity with CMS compliance requirements and ability to monitor delegated third party partners and internal operational areas. Demonstrated ability to resolve CMS audit issues through corrective action plans and proactive process design.



·         Strong communication (verbal and written) and presentation skills.  Ability to articulate a vision in a clear and effective manner that is translatable into aligned action. Ability to mentor internal staff.



·         Demonstrated ability to build capacity consistent with the UHS’ strategic growth targets.



·         Excellent human relations skills with the ability to impact and influence results.



·         Strong project management and plan execution skills with the ability to respond to multiple competing priorities.



·         High energy, positive attitude that encourages productive behavior among colleagues and staff amidst challenging circumstances related to bringing resources into common alignment for the desired outcomes.




Universal Health Services

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Director - Medicare Advantage Operations - (27414)

Universal Health Services
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Universal Health Services

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