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Product Manager (Product Development) - Medicare Advantage
- Seeking a Product Manager with 4+ years of Health Insurance expereince
- Medicare Advantage, Benefit Design & Configuration, and CMS bid process
About Our Client
Our client is the largest not-for-profit home health care agency in the United States, and they are one of the oldest. They have been part of the fabric of New York City since the 1800s. Our client has recently dedicated new resources to their Medicare Advantage product line and is seeking top talent to help grow their health insurance business.
Develops a strong understanding of all our client's strategic business objectives and business unit operations in order to manage the end-to-end product life cycle for one or more of their health insurance products. Drives the development, design, readiness and implementation of new products. Identifies and implements changes to improve existing products. Retires products at end of life.
Collaborates with management to identify and document necessary creation of and changes to policies, workflows, systems, staffing, collateral and product pricing. Facilitates and/or leads teams regarding decision making for the above.
Keeps abreast of the external environment (competitor offerings, DOH/CMS regulations, coalition/affiliation group positions, provider network, membership needs) to identify new opportunities and requirements for health insurance products. Serves as subject matter expert regarding competitive products and plan design in the market.
Analyzes processes and systems to ensure compliance with contractual agreements, CMS standards and DOH regulations. Works with Compliance to evaluate new regulations and operationalizes where necessary. Develops/updates audit programs to ensure product and program compliance.
Collaborates with General Managers, actuaries, pharmacy, clinical and finance staff on annual revisions to product benefits based on organization priorities and financial objectives.
Defines the business and functional requirements/specifications for system implementations and improvements. Collaborates with IT to ensure system design meets operational needs. Participates in testing, training, and roll out of system changes.
Develops project plans and schedules which includes defining requirements, tasks, work assignments, resources, project milestones and review points. Monitors project progress through completion, addressing risks and issues effectively and reporting/escalating appropriately.
Collects and analyzes data to assess and monitor product performance against defined goals and criteria. Prepares and presents summary reports to stakeholders. Identifies opportunities for improvement and works with functional partners to develop strategies to improve results.
Serves as subject matter expert for cross-functional stakeholders including, but not limited to: benefits definitions, provider network management, medical management, claims, sales, and complex customer service. Participates in oversight activities as requested by health plan departments, governance departments (e.g., Compliance and Regulatory Affairs), and senior management.
Manages the development of member written materials, as defined by state and federal regulations, as well as organizational priorities, including but not limited to member handbooks, provider directories, formularies, website, and newsletters
Manages the annual benefit design and submission process for Medicare Advantage, as appropriate.
Collaborates with Marketing department in the development of marketing materials, communications, and collateral to ensure it is on message and supportive of the brand and position.
Performs all duties in a managerial role. Ensures effective staff training, evaluates staff performance, provides input for the development of the department budget, and hires, promotes, and terminates staff and recommends salary actions as appropriate.
Participates in special projects and performs related duties as assigned.
The Successful Applicant
Education: Bachelor's degree in Business Administration, Healthcare Administration or related field of study required. Master's degree in related field desired.
- Minimum five years of experience in product management, with a minimum of three years of experience in a in health insurance organization with a focus on Medicare Advantage OR Medicaid managed care, Managed Long Term Care, FIDA, and Special Needs Plans, required.
- Experience working with benefit design, provider networks, medical management, and claims required.
- Experience with the CMS bid process
- Effective communication, both written and oral, skills and strong skills with common PC software applications (i.e. Microsoft Office) required.
- Excellent analytical, project management and presentation skills, required.
- Knowledge and understanding of Medicare and Medicaid regulations required.
What's on Offer
Commensurate with experience