Medicaid Product Manager/Director

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The Company:

AlohaCare is a local, non-profit health plan serving the Medicaid and Medicare dual eligible population. We provide comprehensive managed care to qualifying health plan members through well-established partnerships with quality health care providers and community-governed health centers. Our mission is to serve individuals and communities in the true spirit of aloha by ensuring and advocating access to quality health care for all. This is accomplished with emphasis on prevention and primary care through community health centers that founded us and continue to guide us as well as with others that share our commitment. As Hawaii’s third-largest health plan, AlohaCare offers comprehensive prevention, primary and specialty care coverage in order to successfully build a healthy Hawaii.

The Culture:
AlohaCare employees share a passion for helping Hawaii’s most underserved communities. This passion for helping and caring for others is internalized and applied to our employees through a supportive and positive work environment, healthy work/life balance, continuous communication and a generous benefits package.

AlohaCare’s leadership empowers and engages its employees through frequent diversity, recognition, community, and educational events and programs. AlohaCare has a strong commitment to support Hawaii’s families and reinforces a healthy work/home balance for its employees. Because AlohaCare values honesty, respect and trust with both our internal and external customers, we encourage open-door, two-way communication through daily interactions, employee events and quarterly all-staff meetings. AlohaCare’s comprehensive benefits package includes low cost medical, dental, drug and vision insurance, PTO program, 401k employer contribution, referral bonus and pretax transportation and parking program.

These employee-focused efforts contribute to a friendly, team-oriented culture which is positively reflected into the communities we serve.

The Opportunity:

The Medicaid Product Director or Manager:
• Is responsible for monitoring and optimizing the performance of the Medicaid product. With a primary focus on assessing performance and making recommendations to improve product performance.
• Coordinates AlohaCare’s response to the Request for Proposal (RFP) bid process.
• Regularly attends meetings with the State of Hawaii Med-QUEST Division (MQD) and serves as a key contact, representing, managing and strengthening AlohaCare’s relationship with MQD.
• Conducts regularly scheduled and an annual comprehensive product review and works with senior leadership to establish product strategy based on identified opportunities. Based on this strategy, he or she works closely with appropriate managers/departments to ensure that all business functions are prepared to deliver the services.
• Is responsible for ensuring that all business functions are adequately trained and prepared to service and deliver the product according to operational guidelines and/or contractual requirements. He or she works closely with claims, membership operations, clinical services, care management, customer (member and provider) relations, sales, marketing, and other departments, as needed, to ensure timely operational implementation of the program that meets contractual and regulatory requirements.
• Regularly monitors ongoing product performance and resolves issues related to benefit design and delivery.
• Supports the business in evaluation of new product concepts, including market assessments, business case development, and implementation.
• Facilitates and assists, as needed, with product analytics, product configuration, and regulatory filings to ensure the fulfillment of organizational, contractual, regulatory and accreditation requirements.
• Facilitates inter-departmental collaboration for projects, process improvement and ongoing operations.

Primary Duties and Responsibilities:

• Conduct regular and annual product planning. Develop product strategy, including proposed product and/or process enhancements, benefit designs, and staffing models
• Develop framework to regularly evaluate product performance and identify central factors that drive key decisions. Activities include, but are not limited to: monitoring key performance indicators such as profitability, utilization (MLR), administrative rate; assessing market share; measuring consumer satisfaction; conducting product, market and competitor assessment, obtaining stakeholder feedback; and consumer research.
• Lead MQD RFP bid process, including development of project plan, stakeholder engagement, and project
management in close collaboration with Finance/Actuarial team and senior leadership.
• Prepare product documentation for timely submission, e.g., Response to RFP.
• Represent AlohaCare at meetings with MQD, health plans, and other forums, as needed.
• Manage reports and other submissions to State of Hawaii Med-QUEST Division per contractual requirements.
• Oversee other annual regulatory submissions, e.g., appropriate filings with state agencies.
• Product implementation and management. Prepare business functions to service and deliver product and/or program, including production of reference tools and product documentation, trainings and presentations to business units/functions
• Oversee implementation of product changes, including directives from regulatory agencies
• Monitor product performance throughout the year, including Appeals & Grievances, membership trends, quality performance.
• Serve as subject matter expert to all business functions when questions arise regarding benefit design and
• Collaborate with appropriate business owners on process improvements, service enhancements and expansions
• Identify opportunities to improve existing products through analysis of consumer, competitor, and regulatory information
• Engage internal stakeholders to assess legal, compliance, operational, consumer, and network considerations and business requirements
• Assess vendors (for new services and product enhancements)
• Develop strategic recommendations, business cases, and present to senior leadership for approval
• Collaborate and coordinate with various individuals and/or departments that assist with product analytics, product configuration, and regulatory filings, providing appropriate delegation and oversight of project work.

• Responsible to maintain AlohaCare’s confidential information in accordance with AlohaCare policies, and state and federal laws, rules and regulations regarding confidentiality. Employees have access to AlohaCare data based on the data classification assigned to this job title.

• Leadership skills to drive accountability/results across departments and among various levels of personnel.
• Strong analytical skills. Ability to problem solve, analyze, think critically, exercise sound judgment and make fair decisions.
• Organizational, project management and stakeholder management skills
• Excellent verbal and written communication skills (in English).
• Must be a self-starter, be able to think creatively, take responsibility, and be extremely resourceful. Ability to multi-task, adapt to changing priorities, manage diverse high priority projects in a fast-paced environment.
• Able to interact and communicate with individuals at all levels in an open and courteous manner.
• Minimum of three (3) years of experience with Medicaid programs
• Knowledge of Medicare and Medicaid programs and regulations
• Minimum of five (5) years health industry experience
• Graduate from an accredited college
• Equivalent combination of education, training and experience
• Requires operation of general office equipment to include; PC, fax/copy machine and ACD Midel Phones.
• Intermediate skill using Microsoft Programs; Word, Excel, Outlook and PowerPoint.
• Individuals with five (5) years of experience with Medicaid, seven (7) years healthcare experience, and prior director roles may be hired at a Director level.
Preferred Requirements

• Strong interpersonal communication skills.
• Public speaking experience.
• MQD or QI health plan experience.

Mental, Physical and Environmental Demands:

• Valid driver’s license and access to an insured car.
• Ability to travel inter-state with occasional overnight stays.
• Available to work evenings and some weekends
• Sedentary Work: Exerting up to 20 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

AlohaCare is committed to providing equal employment opportunity to all applicants in accordance with sound practices and federal and state laws. Our policy prohibits discrimination and harassment because of race, color, religion, sex (including gender identity or expression), pregnancy, age, national origin, ancestry, marital status, arrest and court record, disability, genetic information, sexual orientation, domestic or sexual violence victim status, credit history, citizenship status, military/veterans status, or other characteristics protected under applicable state and federal laws, regulations, and/or executive orders.

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