GENERAL MANAGER MEDICARE ADVANTAGE PLAN, PA/NJ (Hybrid)

COMPANY BACKGROUND
The French Group has been retained by Health Partners Plans (HPP) to recruit a General
Manager for their Medicare Plans. HPP is an award-winning, not-for-profit health plan owned by
Jefferson Health. Serving approximately 300,000 members, HPP has network of more than 60
hospitals and 6,400 providers. In addition to providing significant community outreach, HPP
offers Medicaid, Medicare and Children’s Health Insurance Program plans.

Health Partners Plans has received national recognition for their innovations in managed care.
Their Medicaid plan, recognized as a national model for Medicaid managed care and consistently
receives high ratings for member and provider satisfaction, earned 4.5 out of 5 from the NCQA
Medicaid Health Plan Ratings 2021. Health Partners Medicare offers three Medicare Advantage
plans in the 13-county area and was recently awarded 4 stars out of 5 by CMS.

POSITION SUMMARY
Reporting to the President & CEO, the General Manager Medicare Advantage is responsible for
the operational and financial success of HPP’s Medicare products.

The GM will develop and lead a successful Medicare growth, financial and operational strategy.
She/he will also establish the sales strategy to achieve membership growth across all product
lines within Medicare Advantage HMO and PPO in both PA and NJ. In addition, this position is
responsible for enhancing sales capability to ensure HPP’s continued growth and profitability.
Overall responsibility will be (1) establishing sales strategies reflecting current market trends, (2)
working closely with key departments to ensure successful product profitability, (3) lead
Medicare expansion strategy into New Jersey market and (4) develop internal sales team
capability to create and sustain a high-performing sales organization.

The General Manager Medicare Advantage will also collaborate with STARs, Risk Adjustment,
Care Management and other areas to ensure maximum outcomes are achieved.

PRIMARY RESPONSIBILITIES

Medicare Growth and Retention
• Provide executive level leadership to Medicare Sales Operations and coordinate activities
across the entire Organization.
• Oversee Plan Medicare Sales functions, including financial and budgetary performance,
staffing levels, operational effectiveness and efficiency, legal, compliance, fraud, waste
and abuse, maintenance and reporting of all operational regulatory benchmarks as well as
communications, information systems and technology.
• Strategize and drive organization to become a significant Medicare payor
Strengthen broker relationships to position HPP to become Payor of Choice
• Develop Sales team to enhance performance capability. Establish short and long-range
goals, objectives and plans for HPP’s Medicare Sales Operations.
• Implement a sales strategy that includes appropriate and successful collaboration with
provider network, claims, enrollment, finance, legal, compliance and other departments.
• Continually conduct high level needs assessment, cost analysis and resource requirements
relative to sales systems.
• Collaborate with Chief Development Officer to establish competitive products and
continuously monitor external, competitive environment and network market trends.

Medicare Operations Leadership
• Maintain a positive work environment that supports self-directed initiatives; provide a
structure to optimize the experience, skill, knowledge and capability of the team.
• Collaborate with operational areas to achieve maximum revenue through STARs, Risk
Adjustment, enrollment reconciliation etc.
• Regularly report progress against targets and goals to all stakeholders, including the
Board of Directors, the Finance and Investment Committee and HPP staff.
• Set a tone from the top which fosters an open environment embracing compassion and
high performance while ensuring full compliance with all federal and state regulations
and contractual requirements, and accuracy and transparency in communications.
• Maintain a culture of respect for the diversity of staff, members and providers and
continually strive to ensure that Health Partners Plans is a “best place to work”.
• Encourage innovation in the development of member and/or provider-centric initiatives
and thoughtful and measured risk taking while maintaining an environment of personal
and organizational accountability and responsibility.
• Lead the staff in establishing a professional work environment which fosters
organizational commitment and supports creativity and professional development.
• Establishes collaborative relationships and alliances with internal and external customers.

BACKGROUND/EXPERIENCE DESIRED
• Bachelor’s Degree required; MBA/MHA preferred
• 15+ years’ leadership experience in Medicare Managed Care with proven track record of
growth plus direct budgetary and P+L accountability for operations
• Strong organizational and time management skills
• Excellent oral, written and verbal communication and presentation skills.
• Inspirational leadership style with exceptional staff development and team-building skills
particularly with cross-functional, self-directed teams in a Medicare health plan
• Strong independent decision-making ability with expert project management skills
• Strong influencing, negotiation, conflict management and analytical skills

CONSULTANT
Tricia French RN, BSN
President & CEO
The French Group
(757)362-0202
tfrench@frenchgroup.com