Product Manager - Medicaid

Apply on line at http://www.alohacare.org/Careers/Default.aspx

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 Product Manager is responsible for monitoring and optimizing the performance of the Product (Medicaid/Medicare) through inter-departmental collaboration, research and analysis, and product improvement. All assigned work and projects must be completed within established timeframes.

Primary Duties and Responsibilities:

• Conduct regular and annual product planning. Develop product strategy, including proposed product and/or process enhancements in the areas of vendors, programs, benefit design, and staffing models.
• Works with Finance, Sales and other departments on annual Medicare benefit design and bid development.

• 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, medical loss ratio (MLR), administrative loss ratio; assessing market share; measuring consumer satisfaction; conducting product, market and competitor assessment, obtaining stakeholder feedback; and consumer research.
• Produce product performance dashboard monthly to include membership trends, utilization, service coordination statistics, appeals and grievances statistics, and quality and financial performance.
• Coordinates with Benefits Manager on annual benefit readiness to ensure departments and vendors are ready for annual enrollment period and calendar year benefit changes.
• Product implementation and management. In collaboration with Subject Matter Experts, prepare business units/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 and update or create new reference tools, product documentation, and training materials.

• Collaborate with appropriate business owners on process improvements, service enhancements and expansions.
• Identify opportunities to improve existing products and expand access to services through analysis of consumer, competitor, and regulatory information.
• Engage internal stakeholders to assess legal, compliance, operational, consumer, and network considerations and business requirements.
• Identify and assess vendors (for new services and product enhancements). Collaborate with business owners of external provided services to ensure compliance with product requirements.

• 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.
• Manage and implement a risk adjustment coding program for the specific product.
• Participate in Communications Committee to ensure member and provider communications support product design and strategy.
• Conduct fact checking in support of organizational communications.
• Communicate with appropriate parties to obtain information related to Product (Medicare/Medicaid) activities and document potential areas or risk through monitoring of the activities.
• Other duties as assigned.
• Responsible to maintain AlohaCare’s confidential information in accordance with AlohaCare policies, and state and federal laws, rules and regulations regarding confidentiality.

Requirements:

• Bachelor's degree in business administration, public health, or management
• Minimum of three (3) years of experience with Medicaid and Medicare programs
• Strong understanding of Medicare and Medicaid programs and regulations
• Leadership skills with the ability to drive accountability/results across departments and among various levels of personnel.
• Demonstrated leadership and management experience in effective team building with a focus on continuous improvement.
• 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 regulatory agencies if needed.
• 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
• 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 Mitel Phones.
• Intermediate skill using Microsoft Programs; Word, Excel, Outlook and PowerPoint.
• Proficient knowledge of spreadsheets/graphics, presentation, and databases.
• Valid driver’s license and access to an insured car.

Preferred Requirements

• Confident in public speaking.
• Strong project management experience.
• MQD or QI health plan experience.
• Five years of health care and/or government program experience; specifically, in Medicare and/or managed care and Part D or health plan management
• Ability to predict, present and prepare for various scenarios that impact Part D-specific activities related to the MA-PD and SNP business products.
• 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 for Part D-specific activities related to the MA-PD and SNP business products.
• Ability to comprehend and manage many details at once, and multiple projects impacting Part D-related activities.
• Ability to support business units at critical project points, as needed, and assume a high degree of accountability relating to the success of the Part D-specific activities to support the overall success of the MA-PD and SNP business products.

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

Salary Range: $80,000 - $110,000 annually

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.

Salary : $80,000 - $110,000