Director, Medicare Product Performance
Posted 1 month ago Expired
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Upload Your ResumeAbout This Role
This role is responsible for driving the financial, operational, and competitive success of Medica's Medicare portfolio by prioritizing and executing performance improvement initiatives. The director will ensure Medicare products are financially sound, operationally reliable, compliant, and market-competitive, delivering superior value to members, providers, and the enterprise.
Responsibilities
- Define and monitor Key Performance Indicators (KPIs) aligned to Medicare bid targets and segment goals; establish transparent reporting to communicate goals and execution
- Partner with cross-functional teams (network, pharmacy, clinical programs, Stars, risk adjustment, finance, actuarial, operations) to optimize drivers of competitiveness and address outliers
- Identify performance gaps and lead cross-functional remediation plans, ensuring timely execution and measurable improvement
- Manage program deliverables and hold matrixed partners accountable for on-time, high-quality completion of priority initiatives
- Regularly monitor performance of core KPIs for financial & revenue, medical & pharmacy cost, quality & risk programs, membership & market performance, operations & member experience, compliance, sales & marketing, and value-based care
- Chair the Medicare Product Performance Governance Committee, setting priorities, cadence, agendas, and driving execution of initiatives
- Align cross-functional partners – network, clinical, pharmacy, finance, actuarial, operations, and compliance – around Medicare priorities
- Partner with the VP/GM, Medicare to develop and execute segment strategy, portfolio optimization, and multi-year roadmaps
- Deliver executive-ready insights on threats, opportunities, and infrastructure needs; translate complex data into clear recommendations and decision paths
- Propose structural and operational solutions (e.g., workflow redesign, vendor optimization, benefit configuration changes, product repositioning) and oversee delivery
Requirements
- Bachelor's degree in Business, Marketing, Strategy, Leadership, or equivalent experience
- 10+ years of progressive experience, with 5+ years in leadership roles
- Understanding of Medicare Advantage and/or Cost Plan performance levers
- Strong financial acumen; adept at interpreting and organizing data then turning it into action
- Proven ability to lead through influence, drive cross-functional alignment, and project manage complex initiatives
- Exceptional communication / storytelling and executive presence
- Strategic thinking and planning, project leadership and execution, and general knowledge of operational platforms and third party capabilities
Qualifications
- Bachelor's degree in Business, Marketing, Strategy, Leadership
- 10+ years of progressive experience, with 5+ years in leadership roles
Skills
* Required skills
Benefits
About Medica
Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. They deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.