What are the responsibilities and job description for the Director of Commercial Products position at COMMUNITY HEALTH GROUP?
Job Details
Description
POSITION SUMMARY
Under the direction of the Chief Operating Officer (COO), the Director of Commercial Products is responsible for the quality, compliance and operational performance of Community Health Group’s (CHG) commercial products, including but not limited to Covered California, the state health insurance exchange. Manage all aspects of CHG transition and ongoing operations of all new commercial product development and implementation. This role encompasses strategic planning, implementation, regulatory compliance, operational integration, and continuous improvement efforts to ensure seamless participation in all new products. Responsible for ensuring products and services brought to the market are competitive and sustainable.
COMPLIANCE WITH REGULATIONS
Works closely with all departments necessary to ensure that the processes, programs and services are accomplished in a timely and efficient manner in accordance with CHG policies and procedures and in compliance with applicable state and federal regulations including CMS and/or Medicare Part D, DHCS and DHMC.
RESPONSIBILITIES
- Leads the development and implementation of Covered California with a projected go live date of January 1, 2026.
- Stays current on regulations, industry trends, current best practices, new developments, applicable laws and legislation.
- Develops and implements a comprehensive project plan for CHG’s integration of all new product lines starting with Covered CA. Coordinate with COO to align new product initiatives with CHG’s strategic goals. Identify and mitigate risks associated with the integration process. Oversee the alignment of internal systems and processes with all new product standards. Collaborate with IT, Finance, and all areas of Operations, to facilitate smooth integration. Ensure the accuracy and timely setup of plan details in new product systems.
- Serves as the primary resource for the COO to ensure the organization maximizes the commercial product benefit coverage while containing cost.
- Defines metrics, drives problem solving and root-cause analysis to systematically improve and sustain operations. Drives for continuous process and product performance improvements to meet changing market, consumer, and provider demands. Ensures rigor and discipline of product lifecycle is applied to the annual re certification process and development of benefit design.
- Bridges with regulatory bodies and maintain up-to-date knowledge of applicable laws and policies. Stays current on regulations, industry trends, current practices, new developments, applicable laws, and legislation. Provides technical guidance, consultation, and recommendations for improvement of the organization's policies, procedures, and practices for new products. Ensures appropriate and timely implementation of requirements.
- Oversees the alignment of internal systems and processes with all new product standards. Collaborate with IT, Finance, and all areas of Operations, to facilitate smooth integration. Ensure the accuracy and timely setup of plan details in new product systems.
- Acts as the primary point of contact for new product representatives. Communicates effectively with internal and external stakeholders to keep them informed of progress and changes. Organizes and leads cross-functional meetings and working groups to address integration tasks. Cultivates and maintains positive working relationships at all levels of the organization to ensure positive collaboration to identify, assess, and prioritize upstream and downstream impacts of the new product initiatives throughout the organization.
- Oversees member communication strategies to inform current and potential members about new product options. Including oversight of the development of all new member materials, ensuring regular review and update existing materials to reflect changes in plan benefits, policies, or regulatory requirements.
- Monitors and evaluates the performance of CHG’s new products. Implement feedback mechanisms to gather insights from members and stakeholders. Drive continuous improvement initiatives to enhance plan offerings and member satisfaction.
Qualifications
EDUCATION
- Master’s degree in Managed Care, Public Health Administration, Business Administration or equivalent required.
EXPERIENCE/SKILLS
- Working with Brokers to achieve Membership, margin, and market-share targets.
- A minimum of five years of experience in a progressive leadership role in commercial markets development in a managed care setting.
- 5 years’ experience in managed care.
- 5 years of progressive leadership experience.
- Regulatory and compliance requirements related to commercial products, including but not limited to the California Knox-Keene Healthcare Services Plan Act and Regulations.
- Demonstrated knowledge of health plan operations in commercial plan environment.
- Deep understanding of competitive landscape to develop market strategies.
- Ability to operate a personal computer, telephone, fax, copier.
- Conceptual strength is essential as are analytical, verbal and written communication skills; good public relations.
- California Driver’s License and proof of auto insurance.
PHYSICAL REQUIREMENTS
- Prolonged sitting
- Driving within County
- May be required to work evenings and/or weekends
Community Health Group provides fair employment opportunities. We prohibit discrimination and harassment based on any protected characteristic as outlined by federal, state, or local laws. This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, and trainings. Community Health Group makes hiring decisions based solely on qualifications, merit, and business needs at the time.
The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.
Salary : $220,068 - $269,584
