What are the responsibilities and job description for the Project Manager position at Alignment Health?
Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
The Project Manager manages one or more key projects, with accountability to project queues.
General Duties/Responsibilities (may Include But Are Not Limited To)
N/A
Experience
Job Requirements:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Essential Physical Functions
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.
The Project Manager manages one or more key projects, with accountability to project queues.
General Duties/Responsibilities (may Include But Are Not Limited To)
- Manages complex projects or multiple projects of moderate to difficult complexity
- a. Proactively assess projects for potential problem areas
- b. Implements new markets, systems, and operational projects
- c. Implements project management strategies
- d. Provides trend analysis/review of projects, outputs/solutions to Operations Leadership
- e. Makes recommendations on solutions to operational problems in the organizations
- f. Ensures project objectives are set and roles of team members are clear
- g. Monitors and reviews team outputs from multiple teams
- Leadership role in Service Area Expansions and annual plan benefit bid process, market research, and competitive analysis
- Leadership role in product research of key competitors for filings, bids and selling periods as required
- Point-of-Contact for internal and external departments relating to product initiatives and benefits
- Oversight of vendor management
- Compliance oversight of product implementation in accordance with CMS Marketing Guidelines.
- Maintains good working knowledge of competitor products in the markets and highlight opportunities for the company
- Ensures the accuracy of a variety member facing media for specific Medicare Advantage plans
- Interprets Evidence of Coverage benefits for Appeals and Grievance determination
- Helps develop the product lifecycle work plan. Monitors activities and progress and analyzes results to measure effectiveness
- Maintains subject matter knowledge related to Medicare Advantage service area expansions, notice of intent to apply, bid and implementation planning
- Provides consultation to all internal areas with regards to product designs and capabilities
- Prepares and delivers presentations to senior management, staff members, brokers and external audiences
- Other projects as assigned
N/A
Experience
Job Requirements:
- Required: Minimum 3 years direct experience as a technical, business or project manager, project coordinator or Project Analyst
- Preferred: Experience with CMS Medicare Guidelines for sales, marketing and product including, regulatory interpretation
- Required: High School Diploma or GED. Bachelor's degree or four years additional experience in lieu of education.
- Preferred: MBA
- Required: Advanced project management skills and training.
- Preferred: PMP
- Required:
- Thorough understanding of one or more of the following operations; claims processing, eligibility, membership, utilization management, customer service, and call centers for a managed care administrator or health insurance company
- Ability to interface with multiple departments and/or external clients
- Flexibility/change management skills and ability to translate to staff
- Familiar with the competitive environment of Medicare Advantage plans within your geographic region of responsibility
- Maintains knowledge of state and national government programs, health insurance markets, the reform environment and product trends
- Knowledgeable of all elements of product portfolio associated eligibility guidelines for various election periods with Medicare
- Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.
- Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;
- Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly
- Reasoning Skills: Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution.
- Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.
- Report Analysis Skills: Comprehend and analyze statistical reports.
- Required: None
- Preferred: PMP Certification
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Essential Physical Functions
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
- The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.
- DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email careers@ahcusa.com.
