Program Manager, Medicare Advantage Association Programs
Emergent Holdings

Job Info

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SUMMARY:

The Program Manager, MA Association Programs is responsible for supporting the BCBSA Medicare Advantage Coordination of Care (OOA) program and other interplan projects. Duties associated with this position involve evaluation, implementation and monitoring overall program/project success of MA interplan programs and OOA related initiatives. The role will integrate, align and grow the capabilities of programs and work across business units and teams to identify opportunities, drive improvements and ensure program and project timelines are met. This role collaborates with multiple functional areas requiring a combination of focus and flexibility, as well as a willingness to play an active, behind-the-scenes role. The Program Manager exercises broad discretion and judgment in the acquisition and dissemination of information. The Program Manager understands multiple perspectives of health care, government programs, data exchange standards, nonprofit and for-profit business, operational issues and the impact.

RESPONSIBILITIES/TASKS:

• Manage plan-to-plan, vendor and internal communications to drive operational outcomes for the MA Coordination of Care (OOA) and other interplan programs.
• Manage and maintain on-going data collection and file exchange efforts across the enterprise.
• Plans, organizes, and directs activities of assigned initiatives and programs. Provides project coordination and management of on-going enhancements across the enterprise.
• Evaluates interplan initiatives using a system of data collection & analysis to determine feasibility and effectiveness for go/no-go implementation decisions.
• Leads program meetings and drives key decisions with all stakeholders to define project initiation requirements, ongoing monitoring, success criteria and facilitates conflict resolution and prioritization of implementation/production issues.
• Drives key decisions with all stakeholders to define project/program initiation requirements, ongoing monitoring, and success criteria.
• Establishes a refined body of metrics related to intake, execution, and delivery of initiatives in the clinical operations portfolio.
• Works with project managers and business leads to develop business cases, understand project scheduling, outcomes and assure program objectives are met.
• Maintains and provides information about current projects and potential future projects as required.
• Manages vendor Statement of Work for adherence, renewal, and amendments.
• Manages, in coordination with Finance and Accounting, program finances to include plan fee payments and financial reconciliation.
• Identify, create, establish, and maintain reporting deliverables for budget, performance and project status.
• Research and resolve discrepancies in existing reporting deliverables.
• Clearly communicates policies and procedures as they relate to governance management and metric reporting.

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.

EMPLOYMENT QUALIFICATIONS:

EDUCATION:

Bachelor's degree in Business, healthcare, or a related field. Master's degree in healthcare administration, business or public health is preferred. Relevant combination of education and experience may be considered in lieu of degree. Continuous learning, as defined by the Company's learning philosophy, is required.

EXPERIENCE:

• A minimum of seven (7) years of multi-faceted experience in the healthcare industry, project management environment or a related field with demonstrated technical knowledge that provides the necessary skills, knowledge, and abilities.
• Prior electronic data exchange experience required.
• Three (3) years of leadership experience in previous managed care or healthcare experience preferred.

SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:

• Working knowledge of electronic data exchange concepts, interoperability mandates & standards, file formats and processes.
• Demonstrated leadership skills.
• Demonstrated task and relationship management skills.
• Excellent verbal, interpersonal, and written communication skills.
• Demonstrated knowledge and experience in Medicare Advantage business, risk and quality programs including but not limited to risk adjustment, STARs, HEDIS and provider value-based programs.
• Prior experience working with interplan programs.
• Strong program management leadership, facilitation, negotiation, team coaching, and collaboration skills.
• Knowledge of industry best practices, regarding program and project management principles and tools.
• Proven ability to work independently in a team-oriented environment.
• Ability to plan and carry out responsibilities with minimal direction.
• Strong organizational skills and ability to handle multiple tasks in a fast-paced environment.
• Ability to manage multiple priorities and meet necessary deadlines.
• Ability to effectively exchange information clearly and concisely, present ideas, report facts and other information, respond to questions and employ active listening techniques.
• Ability to apply the principles of independent logical, analytical thinking to define problems, collect data, establish facts and draw valid conclusions.
• Ability to interact with others to build consensus and get decisions implemented.
• Results-oriented and ability to manage multiple tasks simultaneously.
• Ability to handle sensitive and confidential information.
• Demonstrated advanced experience with Microsoft packages, including Project, PowerPoint, Word, and Excel.
• Strong understanding of the importance for detail.
• Skilled at managing stakeholder groups and balancing diplomacy and tact with assertiveness.
• Excellent prioritization skills to balance key priorities.
• Strong customer centric approach.
• Effective in unifying and creating teams of people with disparate skills.
• Courageous and decisive, prioritizes effectively, maintains a clear focus, and sees action through to delivery.
• Energetic, determined, positive, goal focused and consistent, even when under pressure.
• Ability to build trust and demonstrates integrity in all circumstances.

WORKING CONDITIONS:

Work is performed in an office and/or remote setting with no unusual hazards. Occasional travel required.

The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description. We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an \"at will\" basis. Nothing herein is intended to create a contract.

PAY RANGE:

"Actual compensation decision relies on the consideration of internal equity, candidate's skills and professional experience, geographic location, market and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $90,400 and $151,500."

We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an \"at will\" basis. Nothing herein is intended to create a contract.

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