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Director, Medicare Strategy and Product Development

Job Category:  Management/Executive
Department:  Medicare Product

Los Angeles, CA, US, 90017

Position Type:  Full Time
Requisition ID:  8457


Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.

Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

As a condition of employment, L.A. Care requires a COVID-19 vaccine. This requirement includes our remote workforce. If you would like to request an exemption, L.A. Care has implemented a process to consider exemptions, for documented medical conditions and sincerely held religious beliefs. L.A. Care will review all exemption requests prior to proceeding with the recruitment process.

Job Summary

The Director, Medicare Strategy and Product Development provides leadership and drives for the end to end lifecycle for the Medicare (CMC, D-SNP, etc.) product lines.  Responsible for leading strategic initiatives and projects, ensures deliverables are on time and in alignment with LA Care's strategic initiatives.  As an industry expert in Medicare managed care and duals products, leads the development of new product lines and enhancements to existing products. Engages key stakeholders to ensure continuity of product lines and impact of a new product line to the communities served and L.A. Care Strategic Initiatives.  This individual will lead a team responsible for the day-to-day activities to ensure the delivery of products and services to the market are competitive, sustainable, and consistent.


Develops product concepts and strategies for the Medicare segment . Solicit input on market needs from business partners across the organization, distribution channels, and members. Conduct primary and secondary research regarding competitor's strategies, market opportunities, and product trends. Identify trends and patterns, and recommend new or enhanced product concepts and incorporates into plan design process. Identifies member insights that drive behavior change. Prepares concept white papers and business cases for any proposes plan changes within the constructs of the annual product lifecycle timelines.   Collaborate with matrix partners across the company to deliver product solutions in a timely and effective manner.


Lead the Medicare application filing, ensuring all requirements are understood and executed across the enterprise. Lead the rate setting strategy, bid pricing and plan benefit package (PBP) development and submission. Creates project plans that track and mange bid pricing assumptions and development. Manages CMS desk review process and mitigates  issues related to CMS approving the bids. In coordination with Actuarial Services and Finance, oversee execution of any required changes and resubmission of PBPs and Bids. Develop contingency plans for any benefit and premium changes/solves that are prompted via the desk review process.


In partnership with Sales & Marketing develop annual go to market plan that includes an integrated and differentiated sales and marketing acquisition, conversion and retention strategies that achieve membership growth goals. Develops and delivers product trainings, serve as a product expert and a relationship manager to the cross-functional partners.


Oversees and manages the end-to-end development and fulfillment of required annual materials (ANOC, EOC, SB, etc.) for welcome and sales kits. Manages process and timelines from model document population, regulatory approval, design/layout, translation, and print & fulfillment.


Develop goals, objectives and actions plans for department, teams and individuals. Includes full management responsibility for the hiring, performance reviews, salary reviews and disciplinary matters for direct reporting employees.


Direct and manage team(s) to develop and establish rigor and discipline of Product Lifecycle Management is applied to the annual bid development pricing , benefit designs, member material development, and go-to-market strategy.


Perform other duties as assigned.

Education Required

Bachelor's Degree in Health Administration or Healthcare Related Field
In lieu of degree, equivalent education and/or experience may be considered.

Education Preferred

Master's Degree


A minimum of 7 years in Medicare Advantage, with experience serving duals population. Direct experience in bid and PBP development, and member material development.  Risk management and mitigating planning experience.


Minimum of 5-7 years of supervisor/management experience.


Minimum of 10 years of direct experience with duals population and requirements.


Demonstrated Medicare expertise and experience in the following areas: Medicare Advantage strategic planning, bidding, PBP, and member/prospect material development. Deep understanding of Medicare bid concepts, knowledge and timelines. Ability to think strategically with the ability to create messaging to influence desired outcomes.


Ability to interpret CMS communications including memos, guidance, Advanced call letter and Final Call letter for impacts to Product during the year and for impact to Product Development and Benefit Design.


Knowledge of all product/benefit information used in MA member communications, sales, marketing, training, system configuration & CMS attestations.


Excellent interpersonal, leadership, motivational, negotiation, influencing, and communication skills; with success in building, developing, and retaining high performing teams. Successful leadership and change management experience in large complex organizations. Able to lead, manage, conclude and recommend using data and experience driven decisions.  Ability to mentor and coach team through ambiguity and able to make decisions to drive towards and accomplish team objectives.


Ability to lead, orchestrate and facilitate large cross-functional teams to drive for desired outcomes. Oversee due diligence and requirement analysis required for roadmap creation, scope and execution for enhancements and/or product cycle or refresh initiatives.


Ability to manage through risk through change control and/or escalation protocols if necessary.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Additional Information


L.A. Care offers a wide range of benefits including

  • Paid Time Off (PTO)
  • Tuition Reimbursement
  • Retirement Plans
  • Medical, Dental and Vision
  • Wellness Program
  • Volunteer Time Off (VTO)


At L.A. Care, we value our team members’ safety. In order to keep our work locations safe, each employee is required to self-screen for symptoms prior to entering any L.A. Care location each day. L.A. Care and all of its staff are required to comply with all state and local masking orders. Therefore, when on-site at any L.A. Care location, employees are expected to wear a mask in areas where physical distancing cannot be managed.

Nearest Major Market: Los Angeles

Job Segment: Medicare, Relationship Manager, Risk Management, Accounting, Actuarial, Healthcare, Customer Service, Finance, Insurance

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