Product Manager Government Programs (Hybrid/Troy, MI) - Health Alliance Plan

General Summary

This position is responsible for providing independent program oversight for HAP’s Medicaid/Medicare products. This includes the development of the Medicaid/Medicare product strategies, informing and coordinating activities for the operations and sales of the Medicaid/Medicare Product; partnering with other departments on the development and implementation of specific strategies to streamline processes, enhance member satisfaction, enhance growth and increase member retention of the Medicaid/Medicare product. This position will have responsibility to interface with governmental bodies relative to plan rules and regulations and overall impact for the product.

Principle Duties And Responsibilities

• Lead and direct cross-functional activities that provide effective oversight of Medicaid/Medicare Programs, including overseeing the implementation of new or revised program requirements and ensuring that accountable departments have fully implemented and put into practice policies, procedures and processes to meet CMS and other regulatory agency guidelines.
• Act as the conduit for HAP for notices from DIFS, MI Dept of Health and Human Services and CMS relative to program management and filings. Attend meetings with the State as a representative of the plan and ensure that the information presented in the meetings is communicated back to the plan in a timely and accurate manner.
• Work with stakeholders to develop and implement strategies for Medicaid/Medicare membership growth and retention. Track and report on product performance and progress against goals.
• Collaborate with Compliance Officer and Compliance Committee to ensure policies and procedures comply with contractual and regulatory requirements.
• Lead annual process to determine upcoming year benefits, pricing, service area expansion, etc. Gather data necessary for bid, working with Underwriting, Actuaries, Sales, Pharmacy, Network Development, Healthcare Management, Compliance and other areas as appropriate.
• Coordinate and lead work teams to implement benefit changes. This includes filings for benefit changes, service area expansion, contract revisions, annual bid, etc., as well as IT for benefit configuration and operational areas for assessment of operational impacts.
• Participate in workgroups for AHIP and CMS. Attend annual training and conferences.
• Disseminate industry updates and competitive information regarding Medicaid/Medicare products internally.
• Coordinate and oversee operational opportunities to improve product financial performance.
• Perform other related duties as assigned.
  
  

Education/Experience Required

• Bachelor’s Degree in a related field.
• Master’s degree preferred.
• Minimum of three (3) years of experience with Medicaid and/or Medicare programs, specific experience in Medicare/Medicaid Dual Programs preferred. Minimum of five (5) years of experience in a managed care, health care, health plan clinical or financial administration environment, which includes experience with Medicaid and Medicare health insurance programs.
• Demonstrated leadership experience required.
• Strong knowledge of government health insurance programs.
• Strong analytical, creative problem solving, facilitation, critical thinking and decision-making skills.
• Excellent program and project management skills including planning, prioritizing and problem solving.
• Excellent communication skills - written, verbal, presentation and interpersonal.
• Excellent ability to multi-task, influence and negotiate.
• Excellent ability to work in a fast paced changing environment.
• Commitment to service excellence.
• Respect for diversity.
• Ability to work in collaboration with groups and work teams.
• Team spirited.
  
  

Additional Information

• Organization: HAP (Health Alliance Plan)
• Department: Medicare Products
• Shift: Day Job
• Union Code: Not Applicable