Medicare Product Manager
Apply on line at http://www.alohacare.org/Careers/Default.aspx
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.
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 Medicare Product Manager serves as the Subject Matter Expert (SME) and business strategist for AlohaCare’s Medicare Advantage Plus HMO SNP (MA-SNP) program by assisting the organization in determining, defining, and implementing CMS requirements related to MA-SNP mandates.
Primary Duties and Responsibilities:
• Responsible for coordinating cross departmental support for activities to support Medicare line of business. Ensure that other departments throughout the company complete their respective tasks in order to make certain that product development and implementation is successful (for new and existing benefits).
• Provide guidance and research regarding claims configuration, benefit interpretation, and customer service needs to support retention and growth strategies.
• Elevate issues as necessary to keep projects on task and within budget.
• Single point of contact for troubleshooting and ongoing Medicare product support.
• Regularly measures product performance (spend and utilization) in collaboration with Analytics.
• Lead process documentation, project management, progress tracking, and process improvement efforts related to the responsibilities outlined above (i.e. product management/lifecycle calendar, annual product planning).
• Monitor profitability, enrollment, customer satisfaction, in order to recommend new products and product enhancements.
• Develop monthly updates and present comprehensive closing documents bi-annually to Marketing; and other departments as needed to on product/segment performance and to summarize key findings and trends.
• Support key strategic initiatives for the Medicare business, including growth, retention, member experience, Stars-related initiatives, and plan performance.
• Serve as Medicare product “champion” and spokesperson to ensure that internal stakeholders at all levels of the organization are attracted to and fully informed of Medicare product regulatory requirements, marketability, profitability and any changes in the marketplace.
Regulatory Compliance Support
• Develop and maintain an in-depth knowledge of CMS regulations, guidelines and timelines related to benefits; updates to key CMS regulations/programs, including the Medicare Managed Care Manual, HPMS memos, provide strategic insight for impact to AlohaCare Medicare products, and develop recommendations for capturing related opportunities.
• Partners with the Compliance department to ensure all Medicare regulatory requirements are implemented, monitors performance indicators and major risk areas.
• Works with departments to produces a plan of action for any deficiencies noted, keeps Compliance apprised of progress, and tracks to completion.
• Develop and deliver annual Medicare product training to internal and external stakeholders, including customer service, sales, and market leads.
• Responsible for development and dissemination of Medicare product content and guidance; marketing materials and key regulatory materials, e.g. ANOC/EOC and Summary of Benefits EOB, Formularies, Pharmacy and Provider Directory, Provider Manual, Enrollment Form, member and provider newsletters, mass mailer communications to members or providers, and templates for individual member or provider communications
• Notifies management and staff of CMS approved documents, and confirms use of only CMS or compliance department approved documents within the appropriate AlohaCare operational areas.
• Supports annual and other periodic readiness reviews and audits by ensuring that internal and external stakeholders prepare appropriate documentation and information to meet federal and state requirements
• Participates in MA-SNP related workgroups conference calls, CMS calls, or internal and external meetings/conferences.
• Supports annul Medicare Bid process; preparation of bid/re-bid documents for MA-SNP benefits, including benefit design (within the PBP) and implementation (i.e. benefits, enhanced services, criteria, etc.) and other submissions to CMS to effect needed changes.
• Provides any necessary product management input into RFP and related AlohaCare submissions and responses.
• 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.
• Five years of health industry and/or government program experience; Medicare and/or managed care experience desired.
• Leadership skills to drive accountability/results across departments and among various levels of personnel.
• Minimum of three years of direct leadership/management experience.
• Demonstrated leadership and management experience in effective team building and continuous quality improvement programs.
• Ability to define problems, collect and evaluate data, establish facts, and draw valid conclusions, and make appropriate recommendations and decisions.
• Organizational, project management and stakeholder management skills.
• Working knowledge and experience in cross-functional business segments and their integrated influences and relationships.
• Excellent writing skills, verbal communication and presentation skills required.
• Ability to interface with government agencies.
• Strong interpersonal, facilitation, and leadership skills, with the ability to comfortably and professionally interact with all levels in the organization.
• Able to effectively work in a fast-paced and changing environment, manage multiple projects and priorities across multiple teams/projects. Able to effectively and methodically implement, manage, monitor, track and/or report on assigned tasks and projects.
• Ability and experience in successfully working independently and taking a proactive lead when appropriate.
• Strong time management and organizational skills; is dependable, enthusiastic, self-starting, and self-motivated. Uses time effectively, reacts professionally under pressure.
• Requires operation of general office equipment to include; PC, fax/copy machine and ACD Midel Phones.
• Intermediate skills using Microsoft Programs; Word, Excel, Outlook and PowerPoint.
• Proficient knowledge of spreadsheets/graphics, presentation, and databases.
• Bachelor’s degree in business administration, public health, management.
• Project management experience.
• MQD or QI health plan experience.
• Ability to predict, present and prepare for various scenarios that impact MA-SNP.
• Ability to prepare, present and execute work plans to meet target outcomes and deadlines as set forth in the organizational business plans related to Part D activities.
• Ability to translate governmental regulations and guidance to develop effective operational strategies.
Mental, Physical and Environmental Demands:
• 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.
• Ability to travel inter-state with occasional overnight stays.
• Available to work evenings and some weekends
• Inside working conditions
• No environmental hazards
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.Position Description »