Senior Program Manager – Medicare Operations

Job not on LinkedIn

🔥 0 minutes ago

🏄 California, Colorado, +24 more states – Remote

🏄 California – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🐊 Florida – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🦞 Maine – Remote 🌾 Nebraska – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🏈 Ohio – Remote 🌲 Oregon – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⚔️ Virginia – Remote 🧀 Wisconsin – Remote

💵 $105.4k - $152.8k / year

⏰ Full Time

🟠 Senior

📋 Program Manager

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Blue Cross Blue Shield Association

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1960

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Blue Cross Blue Shield Association is an association of independent, locally operated Blue Cross and Blue Shield companies dedicated to providing affordable and comprehensive healthcare insurance plans. It offers a wide range of health plans for individuals, families, and employers, including Medicare options. Blue Cross Blue Shield Association is committed to promoting health equity and supporting mental health initiatives, aiming to make healthcare easy, affordable, and accessible for everyone. The association is active in health care research and advocates for a more equitable health system.

📋 Description

• Manage operations for the Federal Employee Program Medicare Advantage EGWP line of business • Oversee day-to-day operational work streams supporting Medicare products and services • Ensure operational and regulatory compliance with FEP, OPM, CMS, and EGWP policies and procedures • Manage operational efficiencies and continuous improvement initiatives • Support cross-functional operational implementation initiatives enhancing member and provider experiences • Partner with operations, Compliance, Product, Clinical, Network, and Inter Plan & Products teams throughout the product cycle • Manage business requirements, system implementations, UAT, and change management • Ensure CMS compliance and audit readiness • Monitor operations before and after launch, identify execution gaps, and drive in-year corrections • Manage product implementation and operational readiness, including compliant benefit builds • Support enrollment, member services, provider network operations, ANOC/EOC planning, and member experience initiatives • Support strategic planning, multi-year operational roadmaps, and process optimization using Lean Six Sigma and industry benchmarking • Manage vendor relationships, contracts, and RFPs; represent Medicare Advantage operations in governance forums and with CMS • Compile and distribute operational performance reporting, including KPIs, SLAs, regulatory, and operational metrics, to BCBSA leadership • Liaise with FEPOC Operations, present recommendations to leadership, and mentor operational staff

🎯 Requirements

• BS in Healthcare, Business Administration, Public Health, or related field; or equivalent experience • 8+ years of experience in Medicare/Medicare Advantage Operations, healthcare operations, and health insurance or managed care • Deep knowledge of Medicare Advantage, Part D, and CMS regulations • Experience leading/supporting large, cross-functional programs/projects, including working with TPAs/BPOs • Experience with core processing platforms such as Facets, HealthEdge, and QNXT • Strong analytical skills interpreting utilization data, competitive benchmarking, and quality/Stars metrics • Excellent written, oral communication, and presentation skills • Ability to develop and deliver executive-level materials and represent product initiatives to senior stakeholders • Proficiency in Microsoft Office (Word, Excel, PowerPoint) • Familiarity with project management tools and data visualization platforms • Strong stakeholder management and relationship-building skills • Ability to influence without authority across Legal, Compliance, Actuarial, Clinical, and Operations functions

🏖️ Benefits

• Annual bonus incentive pay • Paid time off • 11 holidays • Medical insurance • Dental insurance • Vision insurance • Generous 401(k) matching • Lifestyle spending account • Other benefits available to eligible employees