- Serve as the Sponsor for CenCal Health's Medicare Advantage D-SNP implementation program, working closely with the Chief Operating Officer (Executive Sponsor) and the Senior Leadership Team to prepare for the 2026 D-SNP launch though execution of the D-SNP Roadmap.
- Partner with the D-SNP Program Manager to serve as the primary day-to-day liaison with CenCal Health's D-SNP implementation consultants, supporting ongoing activities and escalating roadblocks or concerns.
- Function as a core member of the D-SNP Steering Committee, leading and/or contributing to one or more tactics required for D-SNP implementation and providing back-up facilitation to the D-SNP Steering Committee Chair.
- Hold responsibility for leading and coordinating the drafting and submission of the D-SNP application and bid to CMS.
- Collaborate with the Senior Leadership Team and staff to support short- and long-term goals/priorities for the Medicare D-SNP, including but not limited to advancing all tactics necessary for D-SNP go-live and integrating tactics through the D-SNP Steering Committee.
- Provide executive-level guidance on Medicare policy, fiscal, and compliance matters.
- Draft and prepare reports for relevant internal and external meetings and in support of the Chief Operating Officer.
- Represent CenCal Health in collaborative Medicare work through the Local Health Plans of California and other associations, as needed.
- Consult with and assist teams in the continued fulfillment of D-SNP responsibilities.
- Collaborate with leadership to support the continued improvement and refinement of core Medicare processes, including but not limited to marketing, quality, network development, and regulatory deliverables.
- Hold responsibility for development of the CenCal Health D-SNP Product, including working cross-functionally to develop and continuously assess and adapt the benefits which will be offered.
- Lead the annual bid submission process, including coordinating with internal stakeholders and preparing, reviewing, and/or finalizing documents for submission to CMS.
- Remain knowledgeable of new and evolving requirements related to Medicare and their interface with Medi-Cal, and brief senior and executive leaders on such requirements.
- Inform strategies and provide subject matter expertise in support of effective outreach, education, and enrollment efforts to recruit and retain D-SNP members.
- Collaborate with the CenCal Health Compliance Department to ensure the D-SNP complies with all relevant regulatory agencies, laws, accreditation standards and regulations, and that all reports and submissions are filed timely and accurately.
- Serve as subject matter expert related to the preparation for, and successful resolution of, all regulatory audits and surveys.
- Attends subject-relevant conferences and represents CenCal Health in association workgroups, as requested.
- Completes other projects and duties as assigned.
- Participate in cross-functional projects and work closely with Directors to achieve desired outcomes.
- Provide oversight of Medicare staff, as applicable, including leading, developing, coaching, and engaging direct reports.
- Prepare annual budget and monitor expenses.
- Prepare weekly, monthly, and/or quarterly reports in support of the Operations Division.
- Clarify values by finding your voice and affirming shared values
- Set the example by aligning actions with shared values
- Inspire a Shared Vision
- Envision the future by imagining exciting and ennobling possibilities
- Enlist others in a common vision by appealing to shared aspirations
- Challenge the Process
- Search for opportunities by seizing the initiative and my looking outward for innovative ways to improve
- Experiment and take risks by consistently generating small wins and learning from experience
- Enable Others to Act
- Foster collaboration by building trust and facilitating relationships
- Strengthen others by increasing self-determination and developing competence
- Encourage the Heart
- Recognize contributions by showing appreciation for individual excellence
- Celebrate the values and victories by creating a spirit of community
- Hold extensive knowledge of Medicare programs and understand their interface with Medi-Cal, including skills to stay abreast of evolving best practices.
- Lead in a publicly accountable and transparent environment and embrace the values of publicly accountable health care delivery.
- Develop and champion innovative solutions to optimize programs for vulnerable populations.
- Serve as an advocate for integrated programs on CenCal Health's leadership team.
- Be a thought leader and adviser to senior leaders; influence executives through experience with data and market practices.
- Think strategically and problem solve.
- Demonstrate strong analytical, problem solving, influencing and interpersonal skills, excellent listening, group presentation and facilitation skills.
- Work in a highly matrixed, mission-driven public organization.
- Communicate clearly and concisely, both orally and in writing.
- Utilize computer and appropriate software (e
- Bachelor's degree in business administration, Health Care Administration or related field required.
- Minimum of 10 years of product implementation and leadership experience required in the administration of Medicare programs, such as Medicare Advantage or PACE.
- Advanced knowledge of the health care industry specific to Medicare, including operations, policy, and regulatory requirements. Experience with CMS audits required.
- Experience working at a leadership level in a health care environment, including demonstrated success at leading cross-functional initiatives.
- Demonstrated expertise in the ability to grow, assess, refine, and improve large programs or initiatives.
-
Medicare Compliance Manager
2 weeks ago
CenCal Health Santa Barbara, United States**Job Summary** · The Medicare Compliance Manager, plays a key role within the Compliance Division, reporting directly to the Chief Compliance Officer (CCO) or alternatively the Compliance Director. This role is responsible for providing leadership and guidance of CenCal Health's ...
-
Medicare Director
5 days ago
CenCal Health Santa Barbara, United States**Salary Range**: $164,689 - $247,034 · **Job Summary** · The CenCal Health Medicare Director will serve as a key leader in the development and administration of the Medicare Advantage D-SNP that CenCal Health will launch in 2026. · The Medicare Director will report to the Chief ...
-
Medicare Compliance Manager
1 week ago
CenCal Health Santa Barbara, United States**Salary Range**: $114,138 - $171,207 · **Job Summary** · The Medicare Compliance Manager, plays a key role within the Compliance Division, reporting directly to the Chief Compliance Officer (CCO) or alternatively the Compliance Director. This role is responsible for providing le ...
-
Health Plan Nurse Coordinator Iii
6 days ago
CenCal Health Santa Barbara, United States**Salary Range**: $101,007 - $151,510 · **Job Summary** · The Health Plan Nurse Coordinator III Lead (HPNC III Lead) is a Registered Nurse assigned to the Enhanced Care Management (ECM) operational unit. The HPNC III Lead performs utilization management activities, telephonic or ...
-
Physician Assistant
2 weeks ago
The Spine and Orthopedic Center Santa Barbara, United StatesPhysician Assistant · About The Spine and Orthopedic Center · The Spine and Orthopedic Center is a well-established and busy private orthopedic, spine, neurology, and pain management practice. We have 4 offices throughout Southern California, including in Santa Barbara, Oxnard, S ...
-
Medical Assistant
2 weeks ago
Santa Barbara Neighborhood Clinics Goleta, United StatesUnder the supervision of the Clinic Manager, the Medical Assistant supports the licensed medical staff in a clinic setting by performing medical back office duties such as performing vitals, obtaining chief complaint, etc. while maintaining high customer service standards. This p ...
-
Employee Benefits Account Manager
1 week ago
Valmark Financial Group Santa Barbara, United StatesJob Description · Job DescriptionDescription: · Your primary role is to ensure the management of the group employee benefits, individual health insurance and Medicare senior supplement coverages. This role entails servicing, educating clients, administrative work of front stage e ...
-
Medicare Grievance and Appeals Manager
2 days ago
Cencal Health Santa Barbara, United StatesJob Details · Job Location · Main Office - Santa Barbara, CA · Position Type · Full Time · Job Category · Member Services · Description · Salary Range: $101,007 - $151,510 · Job Summary · The Medicare Grievance and Appeals Manager is a leadership role within the Member Se ...
-
Medicare Compliance Manager
6 days ago
Cencal Health Santa Barbara, United StatesJob Details · Job Location · Main Office - Santa Barbara, CA · Position Type · Full Time · Job Category · Compliance · Description · Salary Range: · $114,138 - $171,207 · Job Summary · The Medicare Compliance Manager, plays a key role within the Compliance Division, repor ...
-
Medicare Compliance Manager
1 week ago
Cencal Health Santa Barbara, United StatesJob Details · Job Location · Main Office - Santa Barbara, CA · Position Type · Full Time · Job Category · Compliance · Description · Salary Range: $114,138 - $171,207 · Job Summary · The Medicare Compliance Manager, plays a key role within the Compliance Division, reporti ...
-
Talent Coordinator
2 weeks ago
Community Memorial Healthcare Ventura, United StatesCompensation: · **_ Salary Range: $ $35.16 / hour_** · - The pay range above represents the lowest possible rate for the position and the highest possible rate. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee ...
-
Payroll Specialist
2 weeks ago
Community Memorial Healthcare Ventura, United StatesCompensation: · **_ Salary Range: $ $37.18 / hour_** · - The pay range above represents the lowest possible rate for the position and the highest possible rate. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee ...
-
Employee Benefits Account Manager
1 week ago
Valmark Securities Santa Barbara, United States: · Your primary role is to ensure the management of the group employee benefits, individual health insurance and Medicare senior supplement coverages. This role entails servicing, educating clients, administrative work of front stage experience deliverables and back stage templa ...
-
Medical Office Receptionist
2 weeks ago
LHH Recruitment Solutions Santa Barbara, United StatesJob Description · Job DescriptionWe are seeking a highly motivated and customer-focused individual to join our team as a Medical Office Administrator in Santa Barbara, CA . The ideal candidate will be responsible for providing excellent medical customer service while efficiently ...
-
Compliance Strategist
6 days ago
Cencal Health Santa Barbara, United StatesJob Details · Job Location · Main Office - Santa Barbara, CA · Position Type · Full Time · Job Category · Compliance · Description · Salary Range: · $101,007 - $151,510 · Job Summary · The Compliance Strategist will lead the AMO in meeting regulatory requirements and busi ...
-
Compliance Strategist
1 week ago
Cencal Health Santa Barbara, United StatesJob Details · Job Location · Main Office - Santa Barbara, CA · Position Type · Full Time · Job Category · Compliance · Description · Salary Range: $101,007 - $151,510 · Job Summary · The Compliance Strategist will lead the AMO in meeting regulatory requirements and busine ...
-
Psychiatrist
1 week ago
County of Santa Barbara Santa Barbara, United States· Description · NOTICE OF CHANGE 5/21/24: The Position description has been updated with additional information. · SALARY $ $144.89 Hourly $264, $302,398.64 Annually Bilingual allowance when applicable 5% Special Duty Assignment allowance when regularly assigned to the Psychia ...
-
Compliance Strategist
1 week ago
Cencal Health Santa Barbara, United StatesJob Summary · The Compliance Strategist will lead the AMO in meeting regulatory requirements and business objectives through program development and strategic tactics, and through the preparation and filing of reports and related information required by state and federal agencie ...
-
Compliance Strategist
1 week ago
Cencal Health Santa Barbara, United StatesJob Summary · The Compliance Strategist will lead the AMO in meeting regulatory requirements and business objectives through program development and strategic tactics, and through the preparation and filing of reports and related information required by state and federal agencies ...
-
Family Medicine job in: Santa Barbara, CA
3 weeks ago
Archway Physician Recruitment LLC Santa Barbara, United StatesFamily Medicine opening in Santa Barbara CA Full timePermanent openingOutpatient clinicSpanish a plusImmediate needMas salary range is $220kUnder the direction of the Chief Medical Officer, provide comprehensive health care for patients as established by clinic protocols, or acco ...
Medicare Officer - Santa Barbara, United States - CenCal Health
Description
Job Summary
The CenCal Health Medicare Officer will serve as a key leader in the development and administration of the Medicare Advantage D-SNP that CenCal Health will launch in 2026.
The Medicare Officer will provide strategic and cross-functional coordination for the Medicare Advantage D-SNP product and will work collaboratively with responsible leadership across CenCal Health to support the alignment of operational work within the D-SNP Program Structure.
Prior to implementation, the Medicare Officer will serve as the primary day to day liaison with CenCal Health's D-SNP implementation consultants and will work cross-functionally to support execution of the D-SNP implementation roadmap.
Before and after D-SNP implementation, the Medicare Officer will provide subject matter expertise and executive-level guidance relative to Medicare processes and requirements, partnering with the COO to work collaboratively with the Senior Leadership Team to support D-SNP operations.
The Medicare Officer will report to the Chief Operating Officer within the Operations Division and will be a member of the CenCal Health Strategic Leadership Team.
In partnership with the COO and CenCal Health's D-SNP implementation consultants and in advance of 2026, the Medicare Officer will:
Model the Way:
Knowledge/Skills/Abilities
g, Microsoft Office:
Excel, Outlook, PowerPoint, Word) and job-specific applications/systems to produce correspondence, charts, spreadsheets and/or other information applicable to the position assignment.
Education & Experience