Special Needs Plan (SNP) Program Manager

Medica•Madison, WI

5d•$88,800 - $133,245•Hybrid

About The Position

Medica is a nonprofit health plan serving over a million members across Minnesota, Nebraska, Wisconsin, and Missouri. We focus on delivering personalized healthcare experiences and collaborating with providers to ensure members receive genuine care. Our team values accountability, data-driven decisions, continuous learning, and collaboration. Our mission is to be present in the most important moments for our members and employees, fostering a community of connected care where quality service is standard and every member feels valued. The Special Needs Plan (SNP) Program Manager at Medica is tasked with providing a high level of program management and product-specific expertise. This role is crucial for ensuring the performance, quality, and regulatory adherence of our SNP programs and products, as well as maintaining readiness for Centers for Medicare & Medicaid Services (CMS) audits. The Program Manager will closely monitor performance and compliance with CMS regulations and Medica’s approved Models of Care (MOCs). This role also involves leading projects for program enhancements and adapting to regulatory updates. Other duties may be assigned as needed.

Requirements

Bachelor's degree or equivalent experience in related field
5+ years of related work experience beyond degree

Nice To Haves

2+ years care coordination experience
Experience with Government Programs (Medicare, Medicaid, SNP)
Ability to interpret and operationalize regulatory or accreditation requirements
Strong program and project management skills
Experience developing training resources and delivering presentations
Experience working with external regulators and managing audit requests
Clinical experience as an RN, LPN, or social worker (LSW or equivalent) preferred
Ability to work independently and make decisions with minimal supervision
Detail-oriented and solution-focused
Proficiency in Microsoft Word, PowerPoint, and Excel
Strong analytical skills with the ability to synthesize information and recommend actions
Excellent collaboration and influencing skills to drive contributions from non-direct reports
Exceptional written and verbal communication skills for internal and external stakeholders
Experience with regulatory reporting

Responsibilities

Assist with maintenance and submission of Medica’s SNP MOCs
Ongoing monitoring and oversight of SNP MOC implementation, including performance evaluation based on key metrics
Develop and conduct training for internal teams, external delegates, and providers participating in Medica’s SNPs
Prepare for and coordinate responses to audit requests
Perform audits of care coordination activities to ensure compliance with CMS and State requirements
Analyze and translate regulatory requirements into operational processes and monitor implementation and ongoing operational compliance