Medicaid Product Manager

Presbyterian Healthcare Services

1d • Onsite

About The Position

Presbyterian is hiring a skilled Medicaid Product Manager to provide direction and support to functional areas, ensuring optimal performance and program compliance. This role involves identifying and implementing requirements and changes to maintain regulatory and contractual compliance under the Medicaid contract. The manager will represent the organization at Health Care Authority (HCA) / MCO meetings, build effective working relationships with internal partners, HCA, and MCO representatives, and recommend solutions to influence decisions. Presbyterian Healthcare Services is a locally owned, not-for-profit healthcare system founded in New Mexico in 1908. It operates nine hospitals, a statewide health plan, and a growing multi-specialty medical group, employing nearly 14,000 individuals. The health plan serves over 580,000 members statewide, offering Medicare Advantage, Medicaid (Centennial Care), and Commercial health plans. Presbyterian is committed to improving the health of its communities and the well-being of New Mexicans through various initiatives.

Requirements

• Bachelors Degree in related field or a minimum of 6 years experience in application, development and/or implementation of benefit plans associated with HMO, ASO, PPO, and/or Government programs or work with government agencies required in lieu of degree.
• Plus three to five years health plan experience, product or project management, or other directly related experience.
• Excellent organizational skills with the ability to manage multiple priorities with keen attention to detail.
• Excellent written and oral communications skills are required, specifically to communicate with government agencies.
• Must be able to work closely with other team members and function effectively under pressure.

Nice To Haves

• Experience with Medicaid contract and regulations
• Knowledge of Medicaid and health plan operations

Responsibilities

• Provides direction and support to functional areas to achieve optimal performance and program compliance.
• Identifies and implements requirements / changes to ensure regulatory and contractual compliance under the Medicaid contract.
• Represents the organization at Health Care Authority (HCA) / MCO meetings, builds effective working relationships with internal partners, HCA and MCO representatives, and recommends solutions to influence decisions.
• Accountable for product administration and operations that comply with regulatory and contractual requirements under the Medicaid contract.
• Proactively engages functional areas to achieve optimal performance and program compliance as it relates to HCA deliverable and reporting requirements.
• Develops, generates, presents and maintains a variety of statistical reports and records for senior leadership and recommends areas of improvement.
• Works with management to assess product/program needs and objectives.
• Assists in the data-driven decision-making process when faced with uncertainty.
• Ability to correctly frame a business question then determine valid and reliable data elements needed for the best available answer.
• Accountable for all aspects of HCA Deliverable process management including, efficient allocation of resources, collaborating resources and working with Finance to estimate budget impacts.
• Directs various business area teams through the definition, development and implementation of critical processes and systems solutions.
• Effectively represents PHP at HCA / MCO meetings, builds effective working relationships with HCA and MCO representatives, and recommends solutions to influence decisions.

Benefits

• Medical insurance
• Dental insurance
• Vision insurance
• Short-term disability
• Long-term disability
• Group term life insurance
• Other optional voluntary benefits
• Employee Wellness rewards program designed to provide engaging opportunities to enhance health and activate well-being
• Earn gift cards and more by participating in wellness activities like wellness challenges, webinars, preventive screenings

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees