Medicare Product Manager
The Medicare Product Manager is responsible for coordinating all aspects of application, implementation, and operation of a Dual-Eligible Special Needs Plan (D-SNP) for Health Plan of San Mateo (HPSM). This person will be responsible for optimizing the transition for HPSM members from the current Cal MediConnect program into a D-SNP. The position is also responsible for ongoing coordination of all operational aspects of the D-SNP after implementation. Program elements include the annual financial bid submission process, analysis and implementation of annual call letter requirements, coordinating internal communication among departments for ongoing operational and regulatory requirements, as well as serving as the main contact point for the CMS Regional Account Manager. The position will focus on optimizing the Triple Aim: member experience, health outcomes, and financial sustainability.
Your job duties will include:
• Leading the cross-departmental work group that transitions the CareAdvantage Program from the current Cal MediConnect program to a D-SNP, including the development of a transitional project plan and tracking of organizational readiness.
• Coordinating all aspects of the Centers for Medicare and Medicaid Services (CMS) application process, including preparation and submission of required documents.
• Coordinating the work of all internal departments and external actuaries involved in the annual CMS bid process. This includes coordination with the external actuary and internal departments such as Marketing, Compliance, Health Services, and Provider Services.
• Developing, implementing, and leading the internal work group to manage the CMS Stars Rating program.
• Analyzing and communicating the important elements of the annual CMS Call Letter, and form and lead teams that are necessary to implement any changes for the following year.
• Collaborating with Compliance and other departments to ensure HPSM is appropriately addressing all program requirements distributed through ongoing CMS Health Plan Management System (HPMS) memos.
• Coordinating all network adequacy reporting and documentation with Provider Services and other departments to ensure that HPSM meets all network adequacy standards.
• Collaborating with Health Services to develop and implement a Model of Care that meets CMS requirements and enhances health outcomes for HPSM members.
• Coordinating the annual Consumer Assessment of Health Care Providers and Systems, (CAHPS)member survey, as well as analyze results and make recommendations regarding potential adjustments that may increase member satisfaction.
• Coordinating the development and management of analytical reports and dashboards to measure D-SNP performance.
• Coordinating all necessary CMS and state reporting for the D-SNP program.
• Representing HPSM in a variety of state, national, and local coalitions and forums regarding Medicare Advantage and D-SNP programs.
• Keeping abreast of local Medicare marketing conditions and competition as well as national Medicare trends and regulatory changes.
• Supporting the Cal MediConnect Advisory Committee and its successor as the program transitions to a D-SNP.
The following represents the typical qualifications, skills and knowledge necessary to be eligible for this position.
Education and Experience:
• Bachelor’s degree in health administration, public policy, business, social science, or a related field.
• Five (5) years’ work experience in a position requiring knowledge of managed care, Medi-Cal, or Medicare OR any work experience or training that would likely provide the ability to perform the essential functions of this position.
• Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access and PowerPoint.
• Understanding of state and federal managed care program requirements, including Medi-Cal and Medicare health care laws and regulations.
• Comprehensive program planning and development, management, and evaluation skills.
• Cultural Sensitivity; ability to work effectively with all races, nationalities, cultures, disabilities, ages, and sexes.
• Supervisory principles and practices as well as techniques and methods to organize and manage direct reports.
• Thoroughness, ensuring that one’s own and other’s work and information are complete and accurate.
• Customer focus; ability to connect with our members to build engagement and trust.
• Accountability: Takes responsibility for achieving results and meets the expectations that have been set forth.
• Interpersonal awareness: effectively listens to members and ability to notice and interpret others concerns and feelings and ability to communicate with respect.
• Professional demeanor; always acts in a professional manner with members.
• Communicate effectively, both verbally and in writing.
• Excellent research and writing skills.
• Effective public speaking skills.
• Work cooperatively with others.
• Work as part of a team and support team decisions.
• Adapt to changes in requirements/priorities for daily and specialized tasks
• Obtain and retain knowledge of government regulations as they relate to the administration of Medicare Advantage and Duals Demonstration plans.
• Ability to obtain and retain knowledge of the principles and practices of managed care, plan benefits, systems and procedures, changes in Medicare guidelines and regulations, change in health care services, changes in the legal/legislative arena that impact operations.
• Ability to obtain and retain knowledge of health care public policy issues.
• Ability to obtain and retain knowledge of long-term services and supports and managed long term services and supports.
• Ability to take initiative, plan work, and carry out tasks without detailed instructions.
Compensation and Benefits
Starting Compensation Range: Depending on Experience
Benefits Information: Excellent benefits package offered, including HPSM paid premiums for employee’s Medical, Dental and Vision coverage. Employee pays a small portion of the dependent premiums (5%) for medical and dental benefits. Additional HPSM benefits include fully paid life, AD&D, and LTD insurance; retirement plan (HPSM contributes equivalent of 10% of annual compensation); holiday and vacation pay; tuition reimbursement plan; and more.
How to Apply
Application Process: To apply, submit a resume to email@example.com.
The Health Plan of San Mateo is proud to be an Equal Opportunity Employer and is an affirmative action employer. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status.Position Description »