Medicare Plan Management Principal

Medicare Advantage Program Leadership Role

The role leads the design and execution of plan-facing strategy for the Medicare Advantage program. This leadership role serves as the primary architect of how BCBSA engages, educates, and activates BCBS Plans participating in the national MA program — translating national program strategy into actionable, plan-level initiatives that drive adoption, performance improvement, and sustained operational alignment. The role will build and steward the full lifecycle of plan relations: from go-to-market planning and communications design, through change management execution and capability building, to ongoing engagement frameworks that hold plans accountable and support their success.

This role requires a rare blend of strategic vision, healthcare program expertise, stakeholder influence, and the ability to translate complex program requirements — spanning Star Ratings, Risk Adjustment, and Medical Cost Management — into clear, compelling guidance that Plans can act on.

Responsibilities include:

• Serve as the primary relationship owner between BCBSA and the Plans for the national Medicare Advantage program by liaising with Plan contacts, ensuring satisfaction, aligning business processes with strategic goals, overseeing strategy sessions, policy development, and performance metrics, approving budget activities, updating stakeholders, coordinating support teams, and assessing technological efficiencies. Develop and own the annual go-to-market strategy for plan engagement, nuanced for Plan-tier differentiation.
  
  Lead the design of Plan participation structures and accountability mechanisms tied to governance.
• Represent BCBSA in Plan-facing forums and facilitate constructive dialogue. Lead change manage strategy for program evolution, ensuring Plans are prepared for, engaged with and supported through operational, regulatory and strategic transitions.
• Design and manage a comprehensive plan communications architecture – including regular reporting cadences, performance updates, policy notifications, and strategic briefings. Ensure clear and efficient communication with Plans and stakeholders. Build and maintain a plan-facing resource library—including playbooks, reference guides, training, and self-service tools. Promptly address Plan issues, offering support and information as needed. Oversee issue resolution with comprehensive accountability. Relay Plan intelligence summaries to senior leadership.
  
  Support BOM/BOD governance processes by preparing plan-facing communications and briefing materials to contextualize performance outcomes and program expectations.
• Oversee approval of Plans' administrative cost budgets, ensuring adherence to Federal contract limits and managing annual variations in costs.
• Lead and manage a team with the aim of driving effective performance management, fostering professional growth, and creating a positive and inclusive work environment. This role is dedicated to utilizing strong leadership and communication skills to motivate and inspire team members, ensuring they are aligned with and committed to achieving the organization's goals.

The posting range for this position is:

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Qualifications:

• Required BS in Business Administration or other business discipline or equivalent work experience

Experience:

• Required 10+ Years of experience in healthcare strategy, managed care, or health plan operations, with at least 3 years in a leadership level role

Knowledge

Skills and Abilities:

• Essential understanding of FEHBP, including its structure, regulations, and operations for effective management.
• Deep familiarity with Medicare Advantage program structure, including CMS Star Ratings, Risk Adjustment (RAF/HCC), and medical cost management strategies; knowledge of FEHBP and FEP program structure highly desirable.
• Adaptability to FEHBP changes and strategy adjustments as well as adaptability to Medicare Advantage regulatory changes, CMS policy updates, and FEP MA program strategy adjustments in a first-of-its-kind program environment.
• Proficiency in Microsoft Windows, Word, and PowerPoint for communication and presentations.
• Leadership skills to build, motivate, and manage teams, fostering collaboration and resolving conflicts.
• Strategic alignment of team efforts to achieve objectives and results.
• Independent decision-making skills for complex situations.
• Skilled negotiation with external stakeholders like BCBS Plans to maintain positive relationships.
• Effective presentation skills for clear and engaging communication to various audience sizes.
• Ability to gain external customers' understanding and buy-in through compelling presentations.
• Excellent organizational skills for administrative tasks, budgeting, and timeline management.
• Meticulous attention to detail for accuracy, CMS program compliance, and FEP MA governance accountability.