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PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.
Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.
The Senior Director, Product and Regulatory Management is responsible for leading teams in three key domains: 1) the development, implementation, and management of the end-to-end product lifecycle for Medicare and commercial lines of business; 2) efficient and effective commercial business administration; and 3) compliant and effective regulatory communications. Working with company leadership, the Senior Director is responsible for developing and implementing products that achieve membership and profitability targets. In support of strategic business plans developed by the leaders responsible for profit and loss of the lines of business, this position ensures the product lifecycles, annual roadmaps, filings, and communications meet business needs. The Senior Director ensures the organization complies with product, filing, and communication-related processes and timelines, as well as manages major milestones, risk and mitigation planning, tracking and reporting, and communication across the organization. The Senior Director leads product strategy, development, the annual bid process, and corresponding initiatives. The product portfolio includes Medicare Advantage, Dual Special Needs Plan (DSNP), fully insured group business, and Individual offerings, on and off exchange, as well as corresponding regulated filings and materials. The communications portfolio supports regulated communications, predominantly for Medicare Advantage, DSNP, and Medicaid plans. The Senior Director manages a leadership team to deliver on this critical work.
Essential Responsibilities:
Lead the product portfolio development and execution strategy across segments and multiple plan years. Direct the Medicare and Commercial product strategy and portfolio management to ensure profitable growth consistent with business plans. Oversee each step of the work from development to assessment and implementation. Lead, coordinate, and communicate product and lifecycle activities with others in the organization. Oversee successful and timely annual bids, filings, related regulatory submissions, and go-to-market activities.
Oversee development and deployment of regulatory communication materials and processes, including Annual Notice of Change, directories, Evidence of Coverage, handbooks, formulary materials, forms, letters, and other regulated materials.
Oversee the preparation of all filings and compliant regulatory documents across the product portfolio, including health contracts, self-funded materials, and related documents.
Oversee implementation of state and federal benefit mandates, including benefit changes and member communication requirements.
Provide strategic advice for PacificSource teams to ensure plan information is accurate and available timely within required timeframes. Ensure proactive communication of new and revised plan designs and benefits to internal stakeholders.
Develop and improve processes, driving administrative efficiencies and cost savings, including leading in a matrixed environment and emphasizing execution, market positioning, and operational tactics. Drive operational excellence, sustainability, and profitable growth.
Generate local competitive market insights to drive innovation and decision making. Conduct market research, competitive analysis, and financial assessments to evaluate improvement opportunities and business strategies in concert with PacificSource's enterprise strategy. Implement strategies across segments and markets.
Develop structures and processes to ensure compliance, including leading cross-functional teams. Collaborate with Marketing, Sales, Operations, Health Services, and Compliance. Develop strategic business partnerships with internal departments and leaders to ensure strong operating performance, high member satisfaction and quality performance, access, compliance and audit readiness, and sound financial performance.
Work closely with Compliance and others to ensure policies, procedures, workflows, lifecycle strategies, product offerings, and success initiatives comply with state and federal regulations. Participate in compliance audits, activities, and planning.
Negotiate business relationships with vendors and oversee the execution, implementation, and oversight of the contracts.
Develop and monitor departmental budgets and take corrective action as necessary.
Provide leadership and mentoring to the enterprise product team, the business administration team, and the regulatory communications team. Foster leadership development and advancement. Develop succession plans. Manage, coach, motivate, and guide employees.
Support the organization's commitment to diversity, equity, inclusion, and belonging by fostering a culture of dignity, cultural awareness, compassion, and respect.
Supporting Responsibilities:
Meet department and company performance and attendance expectations.
Follow the PacificSource privacy policy HIPAA laws, and regulations concerning confidentiality and security of protected health information.
Perform other duties as assigned.
SUCCESS PROFILE
Work Experience: Minimum of eight years of experience in product, portfolio, lifecycle management, and regulated communications, or substantially equivalent work in highly regulated functions. Exemplary work history with a proven record of success in positions of progressively greater responsibility managing people and achieving business goals and objectives. A solid grasp of the managed care field and insurance regulations is crucial for this role. Experience with strategic planning, communications, sales, product development, regulatory filings, and managing teams required. Leadership experience in a managed care organization requiring advanced knowledge of products, regulatory filings, and regulated communications. Experience with end-to-end product development and lifecycle management of Medicare Advantage, Individual, and group segments, on and off exchange. Experience providing oversight to ensure the successful regulatory filing of all required product materials. Demonstrated success working in a matrixed environment with the ability to set a path and inspire others to follow. Proven record of accomplishment as a driver of process improvement and identifier of efficiency opportunities and ability to lead change. Experience with federal and state regulatory compliance for health insurance plans. Proven ability to quickly assimilate information and make informed decisions; logical, analytical thinker with great influencing abilities; and ability to handle multiple priorities and deal with ambiguity.
Education, Certificates, Licenses: Bachelor's degree required with a focus in health care administration, business, public policy, public health, or a related field. Master's degree or other advanced degree preferred.
Knowledge: Advanced knowledge of Medicare Advantage, DSNP, fully insured group business, and Individual, on and off exchange, along with a deep understanding of the key attributes, competencies, and strategies for success. Advanced knowledge of state and federal regulations. Knowledge of self-funding arrangements is preferred but not required. Strong understanding of managed care and publicly financed or subsidized health care, including the intersection between retail Medicare Advantage, DSNP, and Medicaid. Demonstrated experience and success in working collaboratively in defining and achieving common goals. Ability to communicate, persuade, influence, and negotiate effectively. Comprehensive knowledge of business principles and administration, organization, and management activities, including knowledge of infrastructure and operational requirements needed to comply with regulatory mandates. Excellent verbal and written communication skills. Solid organizational and problem-solving skills with a keen eye for detail. Proficiency in analyzing market trends, conducting competitive research, and developing strategic product and portfolio roadmaps is essential for success. The ability to multitask, prioritize competing demands, and adapt to a changing regulatory environment is key.
Competencies
Authenticity
Establishing strategic direction
Customer focus
Leading change
Empowerment/delegation
Building organizational talent
Coaching and developing others
Passion for results
Cultivating networks
Emotional intelligence
Optimizing diversity
Environment: Work remotely and inside in a general office setting with ergonomically configured equipment. Travel is required approximately 20% of the time.
We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:
We are committed to doing the right thing.
We are one team working toward a common goal.
We are each responsible for customer service.
We practice open communication at all levels of the company to foster individual, team and company growth.
We actively participate in efforts to improve our many communities-internally and externally.
We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
We encourage creativity, innovation, and the pursuit of excellence.
Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.
Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.
