Medicare Perf. Mgmt. & Transformation Dir.

EmblemHealth Inc

  • New York, NY
  • 30+ days ago
  • $113,400–$210,600 Per Year
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Skills

  • Analysis Skillsunmatched
  • Artificial Intelligence (AI)unmatched
  • Business Administrationunmatched
  • Business Caseunmatched
  • Channel Salesunmatched
  • Communication Skillsunmatched
  • Competitive Analysis/Strategyunmatched
  • Content Management Systems (CMS)unmatched
  • Cross-Functionalunmatched
  • Economicsunmatched
  • Establish Prioritiesunmatched
  • Financeunmatched
  • Financial Operationsunmatched
  • Forecastingunmatched
  • Gap Analysisunmatched
  • Healthcareunmatched
  • Healthcare Administrationunmatched
  • Investment Analysisunmatched
  • Leadershipunmatched
  • Management Consultingunmatched
  • Management Strategyunmatched
  • Matrix Managementunmatched
  • Medicareunmatched
  • Microsoft PowerPointunmatched
  • Operational Strategyunmatched
  • Operational Supportunmatched
  • People Managementunmatched
  • Performance Analysisunmatched
  • Performance Managementunmatched
  • Performance Metricsunmatched
  • Problem Solving Skillsunmatched
  • Process Improvementunmatched
  • Process Managementunmatched
  • Product Strategyunmatched
  • Product Supportunmatched
  • Profit & Lossunmatched
  • Project Developmentunmatched
  • Project Management Certificationunmatched
  • Project Planningunmatched
  • Regulationsunmatched
  • Reporting Dashboardsunmatched
  • Root Cause Analysisunmatched
  • SQL (Structured Query Language)unmatched
  • Sales Supportunmatched
  • Scorecardingunmatched
  • Storytellingunmatched
  • Strategic Analysisunmatched
  • Strategic Planningunmatched
  • Technical/Engineering Designunmatched
  • Trend Analysisunmatched

Description

Summary of Position

  • Lead Medicare performance management by connecting strategy and execution; and integrating data, insights, and execution across financial, operational, quality, and growth dimensions.

  • Translate complex analytics into clear priorities, executive-ready insights, and actionable recommendations to support strategic and operational decision-making.

  • Serve as a key partner in the development and execution of Medicare strategy - shaping priorities, investments, and longterm direction.

  • Drive performance improvement and remediation through structured governance, performance reporting (KPIs, dashboards), and disciplined execution across functional teams.

  • Ensure the Medicare business is financially sound, operationally reliable, compliant and market competitive.

Principal Accountabilities

  • Lead Medicare Performance Management & Reporting: define, monitor and evolve Key Performance Indicators (KPIs) and develop enterprise dashboards and scorecards aligned to Medicare segment goals and establish transparent reporting to communicate goals and execution across the organization.

  • Drive Performance Improvement & Remediation: conduct gap analyses; identify root causes; partner with functional teams to design, prioritize, and track remediation initiatives with measurable outcomes.

  • Develop Executive Insights & Presentations: translate complex analyses into clear, concise executive-level presentations, including risks, opportunities and recommendations.

  • Lead Cross-Functional Execution & Governance; chair performance governance forums; align stakeholders; establish priorities; develop project plans and ensure milestone tracking, accountability and delivery of results.

  • Provide Strategic Execution Support Across Priority Gaps: flex into high-priority areas requiring additional leadership or analytical support; rapidly assess issues and drive execution to address performance or capability gaps.

  • Build Strategic & Prioritization Frameworks: support strategy development through strategic assessments, prioritization frameworks, and structured evaluation of initiatives and investments.

  • Support Sales, Product & Competitive Performance Analysis: evaluate sales channel performance, enrollment forecasting, product competitiveness, and market positioning to inform growth and product strategy.

Qualifications

Education, Training, Licenses, Certifications

  • Bachelor's degree in business, Finance, HealthCare Administration, or related field; master's (MBA) preferred.

  • Project Management certification (PMI) preferred.

Relevant Work Experience, Knowledge, Skills, and Abilities

  • 10 - 12+ years of progressive experience in healthcare, with increasing scope and responsibility.

  • 5+ years of Medicare experience (products, regulations, economics, competitors).

  • 4+ years in management consulting or equivalent structured problem-solving environment.

  • Deep understanding of Medicare P&L and key performance drivers.

  • Experience across Medicare product types (MA, SNP, EGWP, PDP, Med Supp).

  • Proven ability to develop and effectively utilize tables, dashboards, and performance scorecards.

  • Experience conducting gap analysis, performance diagnostics, and strategic assessments.

  • Experience developing prioritization frameworks and business cases.

  • Strong financial acumen including P&L tracking and enrollment forecasting.

  • Experience leveraging internal and external data sources (e.g., CMS data, trend reports, primary and secondary research) to drive actionable insights.

  • Ability to translate complex data into clear, decision-ready insights for executive audiences.

  • Proven ability to lead complex, cross-functional initiatives with project plans and milestone tracking.

  • Strong communication and storytelling skills; ability to influence at all levels.

  • Ability to operate effectively in a matrixed organization without direct authority.

  • Experience managing people, processes, or project teams.

  • Advanced proficiency in Excel.

  • Experience with Access, SQL, or similar data tools.

  • Expertise in PowerPoint and executive-level presentation development.

  • Enthusiasm for engaging with AI solutions (e.g., Co-Pilot) to enhance and expedite all deliverables.

Additional Information

  • Requisition ID: 1000003204
  • Hiring Range: $113,400-$210,600

Numbers & Facts

LocationNew York, NY
Salary$113,400–$210,600 Per Year

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